All About Menstruation

Puberty and Periods

Menstruation
(a period) is a major stage of puberty in girls; it's one of the many
physical signs that a girl is turning into a woman.

And like a
lot of the other changes associated with puberty, menstruation can be
confusing. Some girls can't wait to start their periods, whereas others
may feel afraid or anxious. Many girls (and guys!) don't have a complete
understanding of a woman's reproductive system or what actually happens
during the menstrual cycle, making the process seem even more
mysterious.

When girls begin to go through puberty (usually
starting between the ages of 8 and 13), their bodies and minds change in
many ways. The hormones in their bodies stimulate new physical
development, such as growth and breast development. About 2 to 2½ years
after a girl's breasts begin to develop, she usually gets her first
menstrual period.

About 6 months or so before getting her first
period, a girl might notice an increased amount of clear vaginal
discharge. This discharge is common. There's no need for a girl to worry
about discharge unless it has a strong odor or causes itchiness.

The
start of periods is known as menarche. Menarche doesn't happen until
all the parts of a girl's reproductive system have matured and are
working together.

The Female Reproductive System




Body
Basics: Female Reproductive SystemBaby girls are born with ovaries,
fallopian tubes, and a uterus. The two ovaries are oval-shaped and sit
on either side of the uterus (womb) in the lowest part of the abdomen
called the pelvis. They contain thousands of eggs, or ova. The two
fallopian tubes are long and thin. Each fallopian tube stretches from an
ovary to the uterus, a pear-shaped organ that sits in the middle of the
pelvis. The muscles in a female's uterus are powerful and are able to
expand to allow the uterus to accommodate a growing fetus and then help
push the baby out during labor.

As a girl matures and enters
puberty, the pituitary gland releases hormones that stimulate the
ovaries to produce other hormones called estrogen and progesterone.
These hormones have many effects on a girl's body, including physical
maturation, growth, and emotions.

About once a month, a tiny egg
leaves one of the ovaries — a process called ovulation — and travels
down one of the fallopian tubes toward the uterus. In the days before
ovulation, the hormone estrogen stimulates the uterus to build up its
lining with extra blood and tissue, making the walls of the uterus thick
and cushioned. This happens to prepare the uterus for pregnancy: If the
egg is fertilized by a sperm cell, it travels to the uterus and
attaches to the cushiony wall of the uterus, where it slowly develops
into a baby.

If the egg isn't fertilized, though — which is the
case during most of a woman's monthly cycles — it doesn't attach to the
wall of the uterus. When this happens, the uterus sheds the extra tissue
lining. The blood, tissue, and unfertilized egg leave the uterus, going
through the vagina on the way out of the body. This is a menstrual
period.

This cycle happens almost every month for several more
decades (except, of course, when a female is pregnant) until a woman
reaches menopause and no longer releases eggs from her ovaries.
How Often Does a Girl Get Her Period?

Just
as some girls begin puberty earlier or later than others, the same
applies to periods. Some girls may start menstruating as early as age
10, but others may not get their first period until they are 15 years
old.

The amount of time between a girl's periods is called her
menstrual cycle (the cycle is counted from the start of one period to
the start of the next). Some girls will find that their menstrual cycle
lasts 28 days, whereas others might have a 24-day cycle, a 30-day cycle,
or even longer. Following menarche, menstrual cycles last 21-45 days.
After a couple of years, cycles shorten to an adult length of 21-34
days.

Irregular periods are common in girls who are just
beginning to menstruate. It may take the body a while to sort out all
the changes going on, so a girl may have a 28-day cycle for 2 months,
then miss a month, for example. Usually, after a year or two, the
menstrual cycle will become more regular. Some women continue to have
irregular periods into adulthood, though.

As a girl gets older
and her periods settle down — or she gets more used to her own unique
cycle — she will probably find that she can predict when her period will
come. In the meantime, it's a good idea to keep track of your menstrual
cycle with a calendar.
How Long and How Much?

The amount of
time that a girl has her period also can vary. Some girls have periods
that last just 2 or 3 days. Other girls may have periods that last 7
days. The menstrual flow — meaning how much blood comes out of the
vagina — can vary widely from girl to girl, too.

Some girls may
be concerned that they're losing too much blood. It can be a shock to
see all that blood, but it's unlikely that a girl will lose too much,
unless she has a medical condition like von Willebrand disease. Though
it may look like a lot, the average amount of blood is only about 2
tablespoons (30 milliliters) for an entire period. Most teens will
change pads 3 to 6 times a day, with more frequent changes when their
period is heaviest, usually at the start of the period.

Especially
when menstrual periods are new, you may be worried about your blood
flow or whether your period is normal in other ways. Talk to a doctor or
nurse if:

* your period lasts longer than a week
* you have to change your pad very often (soaking more than one pad every 1-2 hours)
* you go longer than 3 months between periods
* you have bleeding in between periods
* you have an unusual amount of pain before or during your period
* your periods were regular then became irregular

Cramps

Some
girls may notice physical or emotional changes around the time of their
periods. Menstrual cramps are pretty common — in fact, more than half
of all women who menstruate say they have cramps during the first few
days of their periods. Doctors think that cramps are caused by
prostaglandin, a chemical that causes the muscles of the uterus to
contract.

Depending on the girl, menstrual cramps can be dull and
achy or sharp and intense, and they can sometimes be felt in the back
as well as the abdomen. These cramps often become less uncomfortable and
sometimes even disappear completely as a girl gets older.

Many
girls and women find that over-the-counter pain medications (like
acetaminophen or ibuprofen) can relieve cramps, as can taking a warm
bath or applying a warm heating pad to the lower abdomen. Exercising
regularly throughout the monthly cycle may help lessen cramps, too. If
these things don't help, ask your doctor for advice.
PMS and Pimples

Some
girls and women find that they feel sad or easily irritated during the
few days or week before their periods. Others may get angry more quickly
than normal or cry more than usual. Some girls crave certain foods.
These types of emotional changes may be the result of premenstrual
syndrome (PMS).

PMS is related to changes in the body's hormones.
As hormone levels rise and fall during a woman's menstrual cycle, they
can affect the way she feels, both emotionally and physically. Some
girls, in addition to feeling more intense emotions than they usually
do, notice physical changes along with their periods — some feel bloated
or puffy because of water retention, others notice swollen and sore
breasts, and some get headaches.

PMS usually goes away soon after
a period begins, but it can come back month after month. Eating right,
getting enough sleep, and exercising may help relieve some of the
symptoms of PMS. Talk to your doctor if you are concerned about your
premenstrual symptoms.

It's also not uncommon for girls to have
an acne flare-up during certain times of their cycle; again, this is due
to hormones. Fortunately, the pimples associated with periods tend to
become less of a problem as girls get older.
Pads, Tampons, and Liners

Once
you begin menstruating, you'll need to use something to absorb the
blood. Most girls use a pad or a tampon. But some use menstrual cups,
which a girl inserts into her vagina to catch and hold the blood
(instead of absorbing it, like a tampon).

There are so many
products out there that it may take some experimenting before you find
the one that works best for you. Some girls use only pads (particularly
when they first start menstruating), some use only tampons, and some
switch around — tampons during the day and pads at night, for example.

Girls
who worry about leakage from a tampon often use a pantiliner, too, and
some girls use liners alone on very light days of their periods.

Periods
shouldn't get in the way of exercising, having fun, and enjoying life.
Girls who are very active, particularly those who enjoy swimming, often
find that tampons are the best option during sports.

If you have questions about pads, tampons, or coping with periods, ask a parent, health teacher, school nurse, or older sister.

Reviewed by: Mary L. Gavin, MD
Date reviewed: October 2010


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