There are studies that show 50% of teenagers undergoing laparoscopy (key-hole) surgery for chronic pelvic pain or severe period pain have evidence of endometriosis.
It is certainly abnormal for a woman regardless of age to suffer from such severe period pains. Taking time off from studies, vomiting, inability to control pain with simple analgesia and the improvement with Yaz all strongly point to the possibility of endometriosis as the cause. Although an initial conservative approach is fine, a referral to a gynaecologist with advanced laparoscopic skills would be warranted. The options are the following:
1- Simple analgesia such as Nonsteroidal anti-inflammatories and paracetamol can be used (Ponstan)- Tried in your case with little success.
2- Restart the COCP and take it continuously with a break every 3-5 months is generally a good approach - This did control the pain and is certainly an option to go back on.
3- A referral to a gynaecologist who can offer laparoscopic (key-hole) surgery. This is a relatively low risk procedure in the hands of an experienced surgeon. Laparoscopy is both diagnostic and therapeutic. Treating the endometriosis (preferrably with excision) followed by medical management would optimize the success of treatment. I would recommend insertion of a mirena IUD at the time of laparoscopic surgery as it has been shown to reduce the recurrence of symptoms of the endometriosis. If the mirena is not an option, the patient can recommence the COCP or start on dienogest.
Such a clinical case as your daughter's, especially after failed medical therapy, would definitely benefit from the input of a gynaecologist.
All the best.
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