The answer

It sounds as though Jenna has primary dysmenorrhoea, which tends to affect women in the first few years after they start menstruating and is not associated with any underlying problems. It is defined as painful cramping, usually in the lower abdomen, which occurs shortly before and/or during menstruation. It can last for up to 72 hours and the pain can spread to the back and thighs. 

Asking Jenna if she has any symptoms other than the pain during her period, such as particularly heavy bleeding (menorrhagia) or bleeding in between her periods, vaginal discharge or pain, or bleeding during or after sex if she is sexually active, is important as these could point towards an underlying health problem that needs medical assessment. 

Assuming Jenna is not sexually active and she has no other symptoms, Vicky should check exactly what Jenna has tried in terms of OTC treatments. NSAIDs such as ibuprofen, and/or paracetamol are the first choice treatments. Jenna should start taking painkillers as soon as her period starts, rather than waiting for the pain to reach its peak. If ordinary painkillers don’t help, referral to a GP may be necessary for a prescription of a stronger painkiller, such as naproxen or codeine.

Jenna’s mum is right in bringing up the pill as a possible treatment option. Combined oral contraceptives have been shown to be an effective way of managing dysmenorrhoea in women who have no plans to fall pregnant. Monophasic combined oral contraceptives are usually first choice, with progestogen-only preparations a viable alternative for those who cannot take oestrogens – for example because they suffer from migraine – after a discussion of their advantages and disadvantages. For both types of contraceptives, counselling is necessary so that the woman understands how to use the product she is prescribed. 

The good news for Jenna is that painful periods tend to improve as women get older. In the meantime, in addition to drug treatments, there are several self care measures that she can try to ease her discomfort, such as exercising, taking a warm bath or shower, using a hot water bottle, gently massaging the lower abdomen, practising relaxation techniques such as yoga or pilates, or using a transcutaneous electronic nerve stimulation (TENS) machine.