THE KID’S DOCTOR: Discussing menstruation with young girls is important
Monday, August 8, 2016

 It is important to ask specific questions about an adolescent’s periods and provide them with good information. 
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By Sue Hubbard, M.D.

   It’s the time of year when I am seeing a lot of my adolescent patients come in over the summer for their checkups. An important part of an adolescent female’s yearly exam is a discussion about her period.  
  The average age of a first period (menarche) is 12.43 years old, and in my practice this has been the norm for the last 30 years. Yes, I do have a few patients who start their periods at 11 years old (and typically their mother’s did as well), but I also have patients who don’t begin their menstrual cycles until they are 14 to 15 years old. Remember, genetics plays a big role in determining the timing of puberty, and there is a wide range of “normal.” 
  While we still talk about younger girls having “irregular” periods in the first one to two years after menarche, studies now show most adolescents have fairly regular cycle intervals (32 days) and bleeding patterns even at a young gynecologic age. Studies also show that 88 percent to 94 percent of girls have menstrual bleeds that last three to seven days, with less than 1 percent having bleeding episodes lasting more than 10 days.
  It is important to ask specific questions about an adolescent’s periods and intervals between her periods (cycle length), as well as length of bleeding. With all of the smartphone apps available to record menstrual cycles, most young girls are pretty savvy and have the dates of their periods. Having a period 28 days apart and then the next being 32 days apart is not “abnormal,” but many girls “worry” if they don’t have a cycle every 28 days. They need to be reassured that there may be a few days of variability every month.
  I also ask questions to see if an adolescent is having excessively heavy periods (but this is sometimes really difficult to judge early on, as a girl doesn’t have a big frame of reference). If a girl feels as if she is having very “heavy” periods I also look at past history for signs of excessive bleeding or bruising as well her family history for any bleeding abnormalities. Having her pay attention to pad count for the next month is sometimes helpful.
  Many young girls (and their mothers) also ask when they may wear a tampon. It is safe to wear a tampon whenever you begin your period. I have a group of adolescents who wear a tampon from the beginning, while I have others who swear “I will NEVER put in a tampon.” It is totally about personal preference. 
  I do let young girls know that if they are going to swim during their periods, they will need to learn to wear a tampon. Many of my patients learn to put in a tampon out of necessity! They are involved in cheerleading, sports or maybe they are going away to a water sports camp. I tell all of them, whether your mother, best friend, camp counselor or the direction on the box teaches you to insert a tampon, once you have done it you realize it is certainly not as difficult as imagined. (One of those check the box moments as a girl!)
  Lastly, I discuss menstrual cramps and how to treat them. Specifically, don’t wait until you are doubled over in pain. It is important to begin an over-the-counter pain reliever like ibuprofen or naproxen when cramps begin. I encourage girls to carry these products in their purse so that they may be more comfortable sooner rather than later. 
Dr. Sue Hubbard is an award-winning pediatrician, medical editor and media host. “The Kid’s Doctor” TV feature can be seen on more than 90 stations across the U.S. Submit questions at The Kid’s Doctor e-book, “Tattoos to Texting: Parenting Today’s Teen,” is now available from Amazon and other e-book vendors.)
Printed in the August 6, 2016 - August 21, 2016 edition.

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