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Treated for GERD. Experiencing nausea and pelvic cramps. Took alessee. What should be done?

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My 11 year old daughter has had her period for 1 1/2 years. Since this summer she has been experiencing increasing boughts of nausea and pelvic cramps. She was treated for GERD and once that was under control, the nausea continued. She is missing soooo much school. She also has very bad period cramps and misses a couple days of school each month. The periods are regular but very painful. Advil did not help. Doctor gave her prescription strengh Anaprox which did not do the job either, but most likely caused the acid/GERD. She was put on Allese and during that time the nausea became more constant (always starts in the morning upon waking). She finished 1 month of Alessee and when she started the first pill of the second pack, she did not sleep all night due to severe cramps and the nausea increased. She's had bloodwork done and everything appears okay. She is currently taking Diclectin (4 pills a day) which takes the edge off of the nausea, allowing her to eat, but it does not take it away. The cramps continue - sometimes strong - sometimes weak. Urgent Care doctor said it was hormones causing this. Puberty hormones. Sent us back to family doctor who is doing bloodwork, ultrasound, etc. again and has given us a prescription for another low dose combination bcp - cannot recall name but it starts with "m" - to be started after her next period. She has bad mood swings as well. No focus at school - actually that has been a complaint for a couple of years now, from the onset of puberty - she was tested and does not have adhd or anything for that matter. Is it hormones???
Posted Tue, 13 Nov 2012 in Women's Health
Answered by Dr. Asra Ishtiaq Ahmed 3 hours later
Hello there.

Menstrual cramps typically do not begin until ovulatory menstrual cycles (when an egg is released from the ovaries) occur and actual menstrual bleeding usually begins before the onset of ovulation.

But certain psychological factors such as emotional stress may increase the likelihood of having uncomfortable menstrual cramps.

Additional risk factors for these cramps include being younger than 20 years of age and starting puberty early that is at 11yrs or before.

The difference between menstrual cramps that are more painful and those that are less painful may be related to the body's prostaglandin (hormone).

Prostaglandin is released at the time of menses but when excess levels are produced which vary from individual to individual, they can lead to sever menstrual cramps.

Menstrual cramps may be accompanied by a headache,nausea ,vomiting and diarrhea. All these are due to effect of Prostaglandin and are normal. They can be relived with use of nonsteroidal antii-inflammatory drugs like mefenamic acid and meclofenamate.

Severe menstrual cramps can be treated with birth control pills like your daughter has been using. These pills prevent ovulation and thereby control the release of prostaglandin relieving the pain.

Other possibility of menstrual cramps can be associated pelvic disease conditions like fibroids, tumors, cervical stenosis which can be ruled out by ultrasound. But your daughter is too young to have these problems.

Eating fruits and vegetables and limiting intake of fat, alcohol, caffeine, salt, and sweets can reduce the intensity of cramps. Regular exercise and reducing stress also have a role.

Considering your child's medical history, I want to know if you got a CT scan of head done at the time when she was having seizures. This is because brain tumors can present with seizures, growth disorders, early puberty and other hormonal problems.

Also wanted to know if it is only school that she avoids during menses or her other activities are also affected.

Hope to hear from you soon.

Take care.

Above answer was peer-reviewed by
Follow-up: Treated for GERD. Experiencing nausea and pelvic cramps. Took alessee. What should be done? 22 minutes later
My daughter had an MRI done of the brain, actually she was on a year long waiting list because she had to be sedated, and the scan came out clear/normal - no tumors. It wasn't until the scan was done that the neurologist confirmed that her seizures were most likely due to growth.

During menses she avoids all activities - at least for a couple of days - not just school. She has missed birthday parties and other "fun" trips because of her period. I also had very painful periods from the time I was 12 until I started to take the birth control pill at 17. I suppose it could be hereditary.

She does have a history of avoidance at school. She has called home many many times last year because she would get a "tummy ache" - either trouble with her school work or she was struggling with friend troubles. She is a bit of an anxious child - I myself had been diagnosed with severe deparession/panic disorder/agorophobia about 15 years ago, before my daughter was born. I remember being an anxious child. I was put on and am currently still taking antidepressants with success - I lead a completely normal life.

Could all of this be anxiety related???
Answered by Dr. Asra Ishtiaq Ahmed 1 hour later
Hello and thanks for writing back.

An 11 year old needs immense psychological and emotional support to understand and get accustomed to her periods for two reasons. First, the menses started earlier than usual in your child and she found herself unable to discuss the same with children of her peer group as it would be a phenomenon completely unknown to her friends or classmates. Secondly, a lot depends on your rapport with her when it comes to alleviating her personal worries related to menses. So if both the reasons which I mentioned are not in her favour, it can lead to anxiety neurosis.

Anxiety neurosis results from failure to adapt to stress and manifests as helplessness, despair, fear, panic, discomfort or mental unrest.
Menstrual cramps perceived as severe can be a manifestation of the same too.

If you have a history of depression, it does not necessarily mean your child would be depressed too. Parents who are absolutely fine can have children who are severely depressed. In other words, the inheritance pattern of depression is not known.

Age of menarche does have a relation with familial history of menarche. So if her menses are early like yours, then it should not be a cause of concern.

It is heartening to know that the MRI is normal and rules out major issues related to the symptoms you mentioned in her history.

Kindly get her evaluated with a child Psychologist who could assume a pivotal role in pacifying her with regard to her discomfort and stress related to her menses.

Take care.
Above answer was peer-reviewed by
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