I am 15 years old and not sexually active. During three or four periods out of the year, I experience painful symptoms such as heavy cramps, nausea, fever, dizziness, and clammy, white skin. A gynecologist recommended that I start taking a low-dose birth control pill to alleviate my symptoms. What are the health risks of the pill for a healthy 15-year-old?

-- Laura

The causes of menstrual discomfort can be many and need to be taken seriously. Too many young women are told to suffer through difficult menses. You do not need to suffer "because menses are supposed to be unpleasant."

Pain that occurs from menstruation itself is called primary dysmenorrhea. This cramping type pain begins with the start of the period and continues while the flow is heaviest. Relief can come from non-steroidal anti-inflammatory drugs (NSAIDs) -- such as Motrin, Advil or Aleve -- or from the use of birth control pills.

Menstrual pain that results from another medical condition is called secondary dysmenorrhea. This may result from abnormalities of your uterus, tubes or ovaries. A more common cause is endometriosis, which may cause central pain or pain on one side. The pain from endometriosis often begins before the onset of menstrual blood flow and often eases up once the flow begins. It may be associated with loose stools or diarrhea and urinary frequency. As the condition gets worse, the pain may progress until it is present during most of your menstrual cycle. Again, NSAIDs and/or birth control pills are a good first-choice treatment, with few or no side effects. In fact, the many health benefits of being on the pill far outweigh any theoretic risks. Your age is not a factor in whether you should or should not consider the pill.

The fact that this pain is not present each month suggests that you may not be ovulating regularly each month. Ovulation is usually necessary to cause the pain in these situations. If NSAIDs together with birth control pills do not relieve your discomfort, laparoscopic surgery is necessary to make sure you do not have a more serious condition and to cut out any endometriosis if it is present. Too often young women are told to ignore menstrual pain. After many years and many physicians, they may finally have diagnostic surgery only to find out that they have severe endometriosis that might have been prevented by more aggressive early diagnosis and treatment.