May 02, 2019
Parents and their daughters often have difficulty determining normal menstrual cycles or bleeding patterns. Young girls might be hesitant to discuss their menstrual cycles or have difficulty quantifying their menstrual cycles. Mothers might consider their daughter’s cycle to be normal (because it is similar to theirs) when it might be abnormal.
Providing moms and their daughters with education about menstrual cycles is important so they know when to seek medical advice.
In the United States, girls get their first menstrual cycle between ages 12 and 13 years on average. Less than 10 percent of U.S. girls will start menstruating before 11 years of age. The age of menstruation has not changed significantly from the early 1970s. Girls will typically start to have a period 2-to-3 years after the onset of breast development.
Educating girls about pubertal development can begin around seven to eight years of age. It’s helpful for parents to talk to their daughters about the changes they are experiencing or will experience during puberty. Parents can emphasize that changes are a natural process while growing up and can happen at different times for her and her friends, but eventually everyone will catch up. Using a puberty book as a resource can assist parents in having these discussions. If parents need help, they can schedule a visit with their pediatric and adolescent gynecologist, pediatrician, or family physician to provide education and helpful resources to use.
Gynecologists like to think of the menstrual cycle as a vital sign, just like blood pressure and heart rate.
When a girl’s breast development begins, it’s a good time to discuss the menstrual cycle, if the conversation has not yet occurred. A girl should not be surprised when she starts menstruating and does not know why or what is happening. Part of this discussion should include menstrual hygiene. Girls should be taught how to prepare for their cycle and how to use menstrual products (i.e. pads). Describe the many types of menstrual products, and that they come in different shapes, sizes and thicknesses. Discuss the importance of changing pads several times a day. Girls might not be home the first time they have a period and should be prepared. A small pencil case or makeup bag with menstrual supplies can be placed in her book bag in the event her first period occurs at school.
For girls who do not want to wear pads, there are options. Period underwear is available for purchase online. This can be helpful for young girls who forget to change their pad through the day when at school, girls who do not like the sensation of wearing a pad, or girls with developmental disabilities.
There are also other menstrual care products including tampons or menstrual cups, which can be used to assist with menstrual flow. Tampons should not be left in the vagina for greater than eight hours. There is a rare serious medical condition known as Toxic Shock Syndrome which results from leaving a tampon in too long. It is important to read the tampon product insertion guide about this condition. If a girl develops diarrhea, a fever, or rash that looks like sunburn, while using tampons, it’s important to call a doctor.
Menstrual cups can be disposable or washable and re-used. They are inserted into the vagina and removed every 8-to-12 hours. Once a girl has her menstrual cycle there are online delivery services to have period products mailed directly to the home.
Gynecologists like to think of the menstrual cycle as a vital sign, just like blood pressure and heart rate. Abnormalities in the menstrual cycle may be attributed to underlying medical issues with a potential for future long-term health concerns. It is therefore helpful for young girls to track their menstrual cycles with either a menstrual app or a calendar. Girls can mark off on a calendar each day they bleed. To determine the interval in between menstrual cycles, count the number of days from the first day of the last menstrual cycle to the first day of the next menstrual cycle. The interval in between cycles is important to determine if the cycle is normal.
Dr. Rachael Polis
If your daughter’s cycle exhibits the following characteristics, you can be confident that all is well. In adolescent girls, normal menstrual cycles occur every 21-to-45 days, they do not last longer than a week, and no more than three-to-six pads or tampons should be needed in a day. During a normal menstrual cycle, girls can lose 4-to-12 teaspoons of menstrual blood. Girls can also have menstrual cramps that cause cramping in their lower abdomen or back during their cycle.
There can be many reasons to seek further evaluation of your daughter’s menstrual cycle. Girls should be evaluated if their menstrual cycles are occurring less than 21 days apart or are greater than 45 days from the last cycle. They should seek medical evaluation if their bleeding lasts longer than seven days, if changing a pad or tampon every 1-to-2 hours, if bleeding is heavy with a history of easy bruising or a family history of a bleeding disorder. Other reasons to seek medical attention include no menstrual cycle after three years of breast development, no menstrual cycle by age 15, or no menstrual cycle by age 14 with a history of eating disorder or excessive exercise. If girls’ menstrual cramps are not well-controlled with a heating pad or a non-steroidal anti-inflammatory such as ibuprofen, she should seek medical advice.
Menstrual cycles are a normal part of pubertal development. Girls should be reassured that having a menstrual cycle should not interfere with activities of daily living. If so, a further evaluation is warranted.
Dr. Rachael L. Polis is a pediatric and adolescent gynecologist at Crozer-Keystone Health System. She sees patients from newborn to 25 years old in Crozer-Keystone OB/GYN offices in Broomall, Media and Upland. Call 610-619-8300 for an appointment.
