What will help ease my daughter's agonising period pain? DR MARTIN SCURR answers questions from readers

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My 22-year-old daughter has terrible menstrual problems. Sometimes she vomits, experiences excruciating pain and sweats and has even lost clear vision temporarily.

The Pill helped, but she came off it and is back to square one. Should she see a gynaecologist?

Name and address supplied.

This problem clearly has a significant impact on your daughter’s life. Many women have period pain, but given the severity of the symptoms you describe, I suspect she has endometriosis.

This is where tissue that usually lines the womb (the endometrium) is found elsewhere, usually in or around other organs in the pelvis, but more rarely in the belly button or even the lungs.

Your daughter’s main symptom is menstrual pain, known as dysmenorrhoea (the vomiting, sweating and temporary loss of vision — which can be a sign you are about to faint — all indicate just how severe her pain is).

Menstrual pain occurs because the endometrial tissue breaks down and bleeds each month. It irritates and inflames the peritoneum, the sensitive membrane in the abdomen (file photo)

This pain occurs because, as with the womb lining, the endometrial tissue breaks down and bleeds each month. Since the blood has no way out the body, it irritates and typically inflames the peritoneum, the sensitive membrane that lines the abdomen.

Also, the extra tissue triggers the production of inflammatory molecules, which add to the pain.

A possible complication of endometriosis is that over time it can cause scarring and adhesions (sticky areas of endometrial tissue that can fuse organs), which can damage the fallopian tubes, potentially affecting fertility (though this is not inevitable).

Though endometriosis is common, experts disagree about the exact cause of the condition and how best to treat it.

In any case, I agree that your daughter should be referred to a gynaecologist for investigations. A pelvic ultrasound scan may provide some information, but the definitive test is a diagnostic laparoscopy, where a thin tube with a camera attached is inserted into the abdomen through a small incision at the belly button.

Drug treatment starts with non-steroidal anti-inflammatory drugs, which suppress the pain. If necessary, this is followed by hormonal therapy to stop menstruation altogether.

Drug treatment starts with non-steroidal anti-inflammatory drugs, which suppress the pain. If necessary, this is followed by hormonal therapy to stop menstruation altogether (file photo)

An example of this is the combined contraceptive Pill, which contains artificial versions of the female hormones oestrogen and progesterone and suppresses menstruation by switching off ovulation. This causes the extra uterine tissue to shrink, leading to reduced bleeding and, in turn, less pain.

As the Pill has been effective for your daughter, her doctor may suggest that she continues with it long-term.

But there are various other hormonal treatments that could also help, such as progesterone-only therapy.

Sometimes, surgery will be offered: here, the tissue is cut away, or an electric current or laser is used to destroy or remove patches of tissue — it’s typically carried out via a laparoscopy.

However, surgery alone is not the whole story as there may be residual patches of tissue that still need to be suppressed.

As the goal of treatment is to prevent the disease progressing, hormonal treatment may still be needed — possibly long-term — to prevent menstruation, with the aim of causing remaining rogue endometrial tissue to shrink.

I have Barrett’s oesophagus and go for a check-up every two years — my next appointment is in July. For a few weeks I have had slight, intermittent pain in the right side of my throat. Is this related? Should I wait for my next appointment or see my doctor again? I’ve also had a cough for six weeks.

Robin A. White, Witley, Surrey.

THE discomfort you are feeling in your throat is, I believe, related to the problem with your oesophagus. Before I discuss the link, I should explain more about Barrett’s oesophagus for other readers.

This condition is a complication of gastro-oesophageal reflux disease (or acid reflux), where acid spills up from the stomach through a valve at the bottom of the gullet, typically (though not always) causing symptoms such as heartburn.

All of us have acid reflux occasionally, but if someone has a weakness in the valve, it can happen more frequently.

And over time, the repeated acid attacks can damage the lining of the oesophagus, causing the cells to change so they resemble the cells of the stomach.

This is Barrett’s oesophagus and it’s what’s known as a pre-malignant condition — that is, in some patients the cells can become cancerous. For this reason, patients with this condition are prescribed medications long-term to suppress acid production — usually a drug called a proton pump inhibitor, such as omeprazole.

Even if a patient has no obvious heartburn, acid reflux can also cause problems such as a cough, sore throat and glue ear (where mucus builds up behind the eardrum, affecting hearing).

This is because the refluxed acid has the potential to get into all these areas, especially when you are sleeping flat at night.

Your cough may be due to a viral infection — it is not unusual for these to last several weeks. But it could be caused by acid reflux, which can flare up even if you are taking medication to suppress it.

The pain in your throat may also be down to bouts of acid reflux — the fact that the pain is intermittent rather than constant is a clue.

At your appointment in July, you will be given an endoscopy (where a thin, flexible tube is inserted into the oesophagus via the mouth) and your specialist will also inspect your throat for evidence of inflammation.

In the meantime, do discuss these symptoms with your GP and ask if you are taking the appropriate dose of acid-suppression medication, as it’s possible you may need a higher dose.

By the way, I found home visits so rewarding

After 37 years as a full-time GP, with at least one weekend in three spent on call, I went part-time two years ago, escaping under the wire as the pressure on GPs started to escalate. I can now see just how lucky I was.

Recently I commiserated with a colleague who is still at the coalface of general practice. I explained the joys of the golden era that I now realise I enjoyed. Though daily house calls were arduous, they were one of the most fulfilling parts of my job and enormously appreciated by patients.

In contrast, he told me he has done only four house calls in the past five years.

Dr Martin Scurr writes: 'Though daily house calls were arduous, they were one of the most fulfilling parts of my job and enormously appreciated by patients' (file photo)

The task of general practice for him and his partners has changed so much that there is no longer time for such �luxuries’.

They are under far too much pressure, with 12-hour days at the surgery. Anyone who phones with an emergency is advised to call an ambulance and go straight to A&E.

Against this background of stressful, non-stop changes in the NHS, in late 2015, Sustainability and Transformation Plans (STPs) were introduced. They are the latest attempt at rearranging the deck chairs on the NHS Titanic.

The STPs are a coming together of NHS organisations and local councils to — wait for it — enhance quality, develop new models of care and improve health, wellbeing and efficiency.

A key feature of the STPs is to cut the number of beds in many hospitals, despite more and more patients going to A&E, increasing emergency admissions and the fact that bed occupancy rates are at more than 85 per cent (many of us will have seen the photographs of ambulances queuing outside A&E waiting to offload patients).

Simon Stevens, the head of NHS England, has acknowledged that reducing the number of beds will work only if there are �credible plans’ for alternatives in the community.

Yet we have a crisis in general practice, with many GPs planning to retire early and fewer new doctors being recruited.

So how can sending sick patients out of hospital possibly be a viable plan if GPs are so tightly under the cosh that, for the most part, home care is history?

Is that really a new model of care?