Title: What knowledge would support improving the management of teenagers with dysmenorrhoea in primary care?
Funder: Department of Health and Social Care

Abstract: Research question:What knowledge would support improving the management of teenagers with dysmenorrhoea in primary care? Background: Dysmenorrhoea is common amongst teenagers, with approximately a third experiencing severe dysmenorrhoea leading to school absenteeism. Dysmenorrhoea occurs in the absence of identifiable underlying pathology but can be associated with conditions including endometriosis.Endometriosis occurs in approximately 10% of adult women and is associated with sub-fertility and chronic pelvic pain. Many adult women with endometriosis report symptom onset in adolescence. Adolescent endometriosis is thought to be under-recognised, with delays in diagnosis potentially contributing to disease progression.Unknowns in adolescent endometriosis include the lack of long-term outcome data, whether interventions in teenagers influence long-term outcomes, and uncertainties about ideal management.My literature search identified no evidence about the incidence, management, or long-term outcomes of teenagers presenting to primary care with dysmenorrhoea.Teenagers' perspectives on dysmenorrhoea (with and without associated diagnoses) are under-represented and are needed to improve care. Aims and Objectives: Aim: To improve the evidence base underpinning the diagnosis and care for teenagers with dysmenorrhoea. Objectives: 1. To determine what is already known about managing dysmenorrhoea in teenagers. 2. To identify and document care trajectories for teenagers recorded as presenting to primary care with dysmenorrhoea. 3. To improve understanding of the symptoms that might suggest the presence of endometriosis in teenagers, starting from their initial presentation to primary care. 4. To explore the perspectives of teenagers experiencing dysmenorrhoea including how, when, why, and where they access information and care, and what they identify as care and support needs. 5. To develop a Healthtalk.org resource for teenagers with period pain that can be used by teenagers, their families or carers, educational providers, and the care settings that support them. Methods: This sequential explanatory mixed-methods study explores adolescent dysmenorrhoea. I will undertake a mixed methods literature synthesis, three sequential projects utilising the QResearch database, and a qualitative study. Within Qresearch; project A evaluates how many adolescents present to primary care with dysmenorrhoea and what treatments they are prescribed, stratified by demographic variables. Project B utilises a retrospective nested case-control study, identifying a cohort of women agedInformed by the findings of our literature and database work, qualitative interviews will be undertaken to identify issues and concerns that matter to teenagers experiencing dysmenorrhoea. We will use these interviews to develop a Healthtalk.org module about teenagers' experiences of period pain. Timeline: Completion October 2026. Anticipated impact and delivery: Research findings will be published in scientific journals and available for guideline development.This project will generate symptom-focussed resources and evidence for primary care, create shared-decision making resources, and represent teenagers' perspectives including a freely available on-line resource.

Lay abstract: My project aim is to improve care for teenagers who suffer with period pain. My approach will identify what matters to these teenagers; explore what happens when they see their GP about their painful periods; and develop new, evidence-based resources for young people and those advising them. Period pain affects up to 93% of teenagers. Approximately one third of them experience severe pain, causing them to miss school and social opportunities. Although treatments are available, most do not seek medical help. This should improve after 2020 when menstrual well-being will be taught in all English schools. However, despite the size and scale of the problem, there is little evidence to guide treatment. While it is important that teenagers with period pain get help in order to reduce their pain and improve school attendance, they also need to be seen in case something (such as endometriosis) is causing their pain. Endometriosis is the abnormal presence of womb-lining tissue outside of the womb. Endometriosis affects approximately 10% of adult women and contributes to infertility and chronic pelvic pain. It is believed to be under-recognised in teenagers, with subsequent delays in diagnosis or treatment potentially contributing to disease progression. In my 2019 study, I interviewed GPs about managing women with symptoms suggesting endometriosis. Many raised questions about how to treat teenagers with period pain, including when to think about endometriosis, whether treating symptoms alone is adequate, and the long-term outlook. In addition, teenagers' perspectives on period pain - critical to successful care -h; are currently under-represented in medical literature. This project seeks to address these issues. This project has been developed with input from teenagers, people who experienced period pain as teenagers, GPs, school nurses, and gynaecologists. The project design and outputs will be developed in partnership with teenagers, parents /carers, and professionals. This project will: Review published research to summarise current knowledge about period pain in teenagers. Use an existing primary-care database (QResearch) to: Record the number of teenagers with period pain who attend primary care, the treatments they receive, and look for patterns which suggest un-met care needs. Explore what symptoms teenagers with endometriosis report to GPs. I will identify a group of women under 24 years of age with endometriosis and another group of the same age who don't. I will look at their records for the 10 years before their diagnosis of endometriosis to see what symptoms they reported and how often they went to the GP. Explore long-term outcomes for teenagers attending primary care with period pain. I will follow a group of teenagers who were seen in primary care with period pain, and a group who weren't, from 1998 to 2018, recording medications, diagnoses, pregnancies, operations, and referrals. I will explore whether treatments might reduce future problems, e.g. infertility or pelvic pain Explore teenage perspectives on period pain, including those with and without diagnosed endometriosis. I will interview teenagers to explore what they think matters when it comes to care, services, and communication about period pain. With their input, I will write accessible summaries about important aspects of painful periods, illustrated with quotations from the interviews. These will create a new section on a widely used health experience website (Healthtalk.org).I will publish my findings in academic papers to make them available for future guidance for doctors. I will create resources to help teenagers make decisions about their care. I will make an online resource about period pain, freely available to inform teenagers, carers, professionals and policy makers. By collaborating with charities and professional organisations, I will share information about our findings and resources.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH