Discussing Menstruation With Your Daughter

Reassure your daughter that menstruation is a normal, healthy part of being female. You can do this not only by what you say, but also by how you say it. Be relaxed and natural. Remember, your attitude and timing in talking with her will play an important role in the development of her own attitudes and feelings.

When Should I Tell My Daughter About Menstruation?

It is most important for her to know what menstruation is before it begins so she will not be frightened or confused by the sight of blood.

On the average, girls begin menstruating at about twelve years of age. However, they can normally start at any time between the ages of nine and sixteen. Because some girls do start earlier, you should introduce the subject to your daughter when she is nine or ten.

Watch for the early signs of physical maturation such as breast development and the appearance of pubic hair and underarm hair. These changes usually precede the start of menstruation.

Should I Wait For Her To Ask Questions?

Some young girls have no knowledge or perhaps a confused awareness of what menstruation is and may never ask any questions. If your daughter has not asked, you should introduce the subject. It is better that she learn about menstruation from you than from her friends who may be misinformed. If she is reluctant or embarrassed to talk about it, introduce the information she will need gradually. It is not essential to review everything during your first discussion. Let her know that you are always available to talk casually about the subject.

You may find it helpful to let her read this article. If she has any questions, she can ask them in a way that will not embarrass her.

What Happens During Puberty?

Puberty is a sign that your child is becoming an adolescent. Changes begin to occur as puberty begins. Breasts will begin to develop, hips will become rounded and/or wider and hair begins growing under the arms and between the legs. Internal reproductive organs (ovaries, uterus, cervix, vagina, and Fallopian tubes) begin to mature and start working.

Special hormones are released during puberty and act as messengers to tell certain glands and organs what to do. These hormones cause and regulate menstruation. Starting to menstruate is a healthy sign that the reproductive system is beginning to work.

At about day 14 of a typical 28-day cycle, the sac bursts and the egg leaves the ovary, traveling through one of the fallopian tubes to the uterus. The release of the egg from the ovary is called ovulation. Some women know when they are ovulating, because at mid-cycle they have some pain - typically a dull ache on either side of the lower abdomen lasting a few hours. Some women also have very light bleeding, or spotting, during ovulation.

After the egg is expelled, the sac - now called a corpus luteum - remains in the ovary, where it starts producing mainly progesterone. The rising levels of both estrogen and progesterone help build up the uterine lining to prepare for pregnancy.

The few days before, during and after ovulation are a woman's "fertile period" - the time when she can become pregnant. Because the length of menstrual cycles varies, many women ovulate earlier or later than day 14. It is even possible for a woman to ovulate while she still has her period if that month's cycle is very short. Stress can sometimes cause a cycle to be shorter or longer.

If a woman has sex with a man during this time and conception occurs (his sperm fertilizes the egg), she will become pregnant.

The fertilized egg attaches to the uterus, and the corpus luteum makes all the progesterone needed to keep it implanted and growing until a placenta (an organ connecting the fetus to the mother) develops. The placenta then makes hormones and provides nourishment from the mother to the baby.

If an egg is not fertilized that month and the woman does not get pregnant, the corpus luteum stops making hormones and gets reabsorbed in the ovary. Hormone levels drop again, the lining of the uterus breaks down, menstruation begins, and the cycle repeats.

In the illustration below, an egg has left an ovary after ovulation and is on its way through a fallopian tube to the uterus.

How Regular Will Her Cycle Be?

The average length of each cycle is 28 days, though a range of 25 to 32 days is normal. It may, however, take time for your daughter's menstrual cycle to establish itself on a regular basis - perhaps as long as two or three years.

One reason is that ovulation, the release of an egg cell by one of the ovaries, often does not begin to occur regularly until a year or two after menarche (a girl's first period). Initially, your daughter's period may come earlier or later than expected or she may miss a period completely. Do not be alarmed. Even once the cycle is established, it may vary from month to month.

The flow usually starts slowly. It does not spurt or gush like water from a faucet. The flow is usually heaviest during the first few days and then slows down and stops. Initially, the color will be brownish-red and then will lighten to a rust color as it slows down.

Menstrual Bleeding: What is Normal?

Most menstrual periods last from three to five days, but anywhere from two to seven days is normal. The amount of blood flow varies, too, but for most women, bleeding starts out light at first, followed by heavier flow for a day or two and then another light day or two.

The amount of bleeding varies from woman to woman because everybody's body has a different way of building up the lining of the uterus. A lighter flow or heavier flow does not mean you cannot get pregnant as easily or you are never going to get pregnant, or that your periods will always stay the same way.

But if you are bleeding excessively - soaking one or more tampons or pads an hour - please call our office.

What Should I Say About Vaginal Secretions?

Your daughter may notice a clear or whitish secretion on her underpants between periods. Let her know that normal vaginal secretion is another sign that she is maturing physically. The secretion varies throughout the cycle, appearing clear and thin at mid-cycle and grayish-white and thick at other times.

Reassure your daughter that this is normal and she should not be concerned. If the secretion becomes excessive or if it is accompanied by irritation, itching, swelling or odor, please call our office.

What If She Is Later In Starting Than Her Friends?

Each girl is unique in term of her biological development timetable. Your daughter is growing at a rate that is right for her body. It is normal that some girls do not begin to menstruate until age 16.

If you or she is concerned about a delayed onset of menstruation, please call our office for advice.

Should My Daughter Limit Her Activities During Menstruation?

Reassure her that there is no reason to change her everyday normal activities during menstruation. She can participate in sports or dance or do whatever she normally enjoys doing at any other time of the month.

In fact, girls who exercise regularly and stay physically active throughout the month often experience less discomfort during menstruation and feel little need to restrict their activities.

Can A Diet Or Change In Weight Affect The Cycle?

A gradual loss or gain in weight does not usually affect the menstrual cycle but crash dieting can. A diet, which results in sudden, significant weight loss or poor nutrition can disrupt the cycle or stop the menstrual flow temporarily. Similarly, a large weight gain can also affect the cycle.

Are Clots In The Menstrual Flow Normal?

Small clots are occasionally found in the menstrual flow. They occur more often when the flow is heavy because the blood is not completely changed into fluid form before being discharged. If the clots are very large and numerous, please call our office.

What Kind Of Menstrual Protection Products Should My Daughter Use?

There are a wide variety of protection products available today. Because they satisfy different needs both during and in between her periods, your daughter should try a variety of products to choose the ones that are right for her.

Most girls use either menstrual pads or tampons. They come in different sizes and shapes. Pads are worn inside panties while tampons are worn inside the vagina. Pads and tampons are labeled as super, regular, medium, and mini. Super means that the pad or tampon can absorb more; they are for days when flow is heavier. Regular, medium, and mini refer to pads or tampons that absorb less, and can be used when flow is less.

Which Is The Best Product To Use?

Most girls use whichever is easiest and most comfortable. Girls may choose to use pads for some occasions and tampons at other times. Tampons should never be worn overnight or used for extended periods as they have been associated with Toxic Shock Syndrome (see below).

Can Tampons Damage The Hymen?

The hymen is a thin fold of tissue partly covering the vaginal opening in women who are virgins. Using tampons carefully will usually not hurt the hymen.

What Is Toxic Shock Syndrome?

Women who use tampons should be aware of toxic shock syndrome, or TSS, a rare but serious and sometimes fatal disease that has been associated with tampon use. Tampon packages carry information about TSS on the box or inside. Because TSS mostly affects 15 to 19 year olds, it is especially important for teenagers to know what signs to look for. If you develop the following symptoms while menstruating, remove the tampon and get medical help right away:

• sudden fever over 102 degrees Fahrenheit
• vomiting
• diarrhea
• dizziness, fainting, or near fainting when standing up
• a rash that looks like a sunburn.

The low risk of getting tampon-associated TSS can entirely be avoided by not using tampons. If you choose to use tampons, it may be possible to reduce your risk by alternating tampons with pads during your period. It is advisable to use a tampon with the minimum absorbency that you need to control your menstrual flow.

What Should I Tell My Daughter About Menstrual Discomfort?

It is important for her to understand that menstrual discomfort, while it is experienced by some, is not something every female should expect. In fact, many girls and women experience little or no discomfort and are hardly even aware of having their periods.

Sometimes, however, cramps or lower backache may develop. A warm bath or heating pad applied to the abdomen or back for 30 minutes may provide temporary relief. Regular exercise throughout the month, including during menstruation, may help or eliminate discomfort.

Some girls and women feel more tired or irritable just before their periods, while others notice a bloating of the abdomen and breasts. But these symptoms are temporary and often hardly noticed within a busy schedule.

What Causes Menstrual Pain?

Prostaglandins are hormones normally produced by the body and are responsible for causing menstrual pain.

What Can Be Used To Treat Menstrual Pain?

Plain acetaminophen products like Tylenol and Aspirin-Free Anacin help to relieve menstrual pain. It takes time for pain relievers to work, so it is best to take them before the pain gets bad and continue for one or two days, as needed.

NSAIDS (nonsteroidal anti-inflammatory drugs) are used to relieve menstrual pain. NSAIDS work by suppressing prostaglandins, thus easing cramps. NSAIDS work best if taken 1-2 days before the beginning of the period.

Prescription NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Anaprox). Ibuprofen, 200-800 mg, can be used every 6-8 hours as long as this dose does not cause abdominal discomfort.

Ibuprofen (Motrin IB / Advil / Nuprin) available over the counter as 200 mg and naproxen (Aleve) available over the counter, can be used to treat menstrual pain.

Like NSAIDs, aspirin also suppresses prostaglandins, but it is often not as effective as other NSAIDs for menstrual pain. Before checking with a doctor, aspirin should never be used by children or teenagers who have chickenpox or flu symptoms. This is because Reye syndrome, a rare but sometimes deadly illness, may develop in children and teenagers who have taken aspirin or products that contain it while they were sick with chickenpox or flu.

Several OTC products, such as Midol and Pamprin, are specifically formulated for menstrual symptoms. Read the labels of these medicines before you buy them, because different formulations often contain different ingredients or strengths of ingredients. For example, Teen Formula Midol contains acetaminophen for pain and pamabrom (a mild diuretic) for fluid retention. Pamprin contains acetaminophen, pamabrom and pyrilamine maleate (an antihistamine) for tension and irritability. Cramp Relief Formula Midol IB contains ibuprofen as its sole ingredient. Manufacturers may change their products' ingredients from time to time, so it is a good idea to check the label each time you buy the product.

If any form of menstrual discomfort becomes severe, however, please call our office.