Go With The Flow

Start talking about menstruation to your daughter early and often

It can be hard for a parent to know just when to start talking to their daughters about periods. The time when the period starts can be frightening for a girl, especially if it happens outside the home. In general, it’s a good idea to bring up the subject (in terms that  hey would understand) at about the age of 9 to make sure they’re prepared for the big day. If they have a friend who has started, that’s a very good opportunity to open a discussion; to say, “Hey, what do you think about that? What do you think is going to happen to you? Do you want to talk about it?” Using TV ads for sanitary pads or tampons can also be a good way to start a conversation. Or simply ask your daughter what she already knows.

Starting to have periods is a part of growing up for girls. Periods usually start to occur around the same time as other changes happen to the body, such as starting to develop breasts or to grow pubic or underarm hair. Most girls get their period between 12 and 13 years of age—however, it can be anywhere between 9 and 15, and in a small number of girls it can even start a bit earlier or a bit later. If a girl hasn’t started her period by the age of 16, then she should visit a doctor for a checkup. It doesn’t mean that anything is seriously wrong, it just means that we have to find out why. Some common reasons are stress, overexercising, under-eating, loss of weight, obesity, or a hormonal imbalance.

The Basics
So what happens during a period? It’s the time of each month, for several days, where some blood will be discharged  through the vagina from the lining of the womb following hormonal changes. The amount of blood that is lost varies between girls, although the heaviest blood flow is within the first few days.Bleeding can last from one to eight days, but on average five days is normal.

Prior to and during the period, some pain in the abdomen—period pain— is normal and common. Hormonal changes can also cause water retention in  various parts of the body causing breast tenderness and slight enlargement, and the tummy may swell a little before a period. Headache, fatigue and mild  mood changes can also be common—to have such symptoms before a period is normal. Sometimes the symptoms prior  to periods can be more severe. This is then called “premenstrual syndrome” or “premenstrual tension.”

When such symptoms do happen and they start to interfere with a girl’s life—for example, she doesn’t want to go to school, she’s prevented from doing any exercise, or it’s affecting her general wellbeing or mental health—then it is certainly recommended to see a doctor, especially if her symptoms are really bad from the first-ever period or if each cycle is getting worse and worse .

Females have small organs called ovaries in the lower part of their tummy. The ovaries lie on either side of the uterus (womb). The ovaries start to produce female hormones in girls around puberty, which causes changes to the lining of the womb. This is what causes periods.

The menstrual cycle is the time between the start of one period and the start of the next one. The average length of a menstrual cycle is 28 days—however, anything between 24 and 35 days is common.

During the cycle, various changes occur in the body. The changes are controlled by chemical substances called hormones, which act like messengers.

There are two main female hormones that trigger periods—estrogen and progesterone, which change in amount during the cycle. In the first half of the cycle, estrogen increases and causes a thickening of the lining of the womb; it gets very thick and very red and boggy. Ovulation occurs about halfway through the cycle (about 14 days after the start of the period). Ovulation is a release of an egg into the fallopian tubes (the tubes  connecting the ovaries to the womb). During the second half of the cycle, after ovulation, progesterone increases. Progesterone then causes a swelling of  the wall of the womb so that it is ready to receive a fertilized egg. If the egg is not fertilized, the levels of progesterone and estrogen fall, and a sloughing/shedding of the wall of the womb occurs, and a new cycle begins.

Symptoms Relating to Periods
In general, if a girl experiences a change from the usual pattern that lasts for several periods, it may be abnormal and she should see a doctor. Some common complications that can occur are painful periods, heavy periods, and irregular periods.

Irregular periods
Irregular periods are common during the first 1–2 years of starting periods. Teenagers don’t usually produce an egg with each cycle (an “anovulatory  cycle”) due to an imbalance of hormones.Because of that imbalance, eggs are not released, and the uterus breaks down outside the perfect 28-day cycle. Eventually, it all balances out, and you get the whole nice cycle of eggs being released at 14 days, just when the uterus is ready, and then if pregnancy does not occur, you shed everything at about 28 days.

If periods are still irregular after the first two years of starting, or if the girl has bleeding in between her periods, she should see a doctor.

Periods That Stop (Amenorrhea)
Pregnancy is the most common reason for periods to stop. However, it is not uncommon to miss the odd period for no apparent reason. Apart from pregnancy, other causes of periods stopping include stress, losing weight, exercising too much and hormonal problems such as Polycystic Ovarian Syndrome (POS), or thyroid disease

Heavy Periods (Menorrhagia)
This is common. Periods are considered heavy if they are affecting your life and causing problems. For practical purposes, a period is probably heavy if it causes flooding through to clothes or bedding, frequent changes of sanitary towels or tampons, the need to wear double pads, passing large blood clots, or restrictions to normal life activities because of the heavy bleeding.

Some causes of heavy periods are fibroids, infections, hormonal changes, blood clotting disorders (this should be especially considered in girls who have had heavy periods since menarche) and in many cases the cause is unknown.

Painful periods (Dysmenorrhoea) 
It’s common for girls to experience an ache in the lower abdomen, back and the tops of the legs, especially in the first few days of a period. Some girls have more pain than others. In most cases, the cause of the pain during periods is not clear. When the pain is severe enough to affect her day-to-day activities, she should see a doctor. While sometimes a cause is not found, some causes are infection, fibroids and endometriosis. The doctor will normally ask about any other associated symptoms such as fever or vaginal discharge.

One cause of painful periods is something called endometriosis, which is when some of the cells or tissue of the lining of the womb are found outside  of the womb, such as in the fallopian tube, the ovaries; and sometimes they’re present in the peritoneal cavity, which is the mass of ligaments and tissues surrounding the womb and the ovaries. They can be tiny, little balls of cells and tissues, and they respond the same way as the lining of the uterus does to hormones. So if these little bunches of cells end up anywhere else, they can cause period-type pain. Sometimes endometriosis can cause heavy bleeding. After diagnosis of endometriosis a doctor will discuss several options for treatment.


Is the menstruation the first manifestation of puberty?
Not necessarily. It could be pubic hair, underarm hair, body odor, or breast development—it’s different for different girls.

What is the proper age to wear a tampon?
You can start whenever you want, but many teenage girls are uncomfortable with them and they can take some getting you used to. It may be advisable to start out with sanitary pads, just to get used to the period first, and then moving onto tampons. Tampons come in different sizes and styles, so starting with the smallest one would be the most appropriate to get used to it Larger sizes can be used if your period is heavier or during the night. Sometimes you may like to mix and match- using tampons for swimming but pads at other times.

Are tampons more convenient to use than pads?
From a certain point of view, they can be more convenient—for example, if you wanted to go swimming you could use tampons as opposed to sanitary pads. Often girls find that in their first few days of a period, they prefer pads more than tampons, because they’re changing quite regularly, but this is just a preference. Some people prefer using pads for the first few days, and then when it slows down they can use tampons, which they can leave in for a few more hours, and it becomes a little easier. It’s about what’s right for you; there’s no right or wrong way.

Is pregnancy possible from the first period?
Yes it is possible, although, as discussed above, most girls do not always release an egg with each cycle in the first 1-2 years.

Can you get pregnant during your period?
Although unlikely, it is possible to get pregnant by having sex during your period. Sperm can stay alive inside you for up to five days, so if you ovulate early and have a short menstrual cycle, then it is possible to become pregnant

Is depression a normal symptom of menstruation?
Depression is not a normal symptom. Irritability and fatigue can be expected, but depression could be a sign of more serious premenstrual syndrome. You should see a doctor.

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