Menstruation Matters

By: Dr Natalie Hutchins

Osler Health - Star Vista
Posted on: 1 Dec 2023

Puberty can be a tumultuous time for any tween navigating fluctuating hormones, changing bodies and unpredictable social dynamics, so it is no wonder periods can be an unwelcome addition for many girls and their parents.  It is, of course, an inevitable part of growing up and when approached calmly and practically, it is a transition that many girls will make with ease.

  1. Reassure

Bleeding is usually associated with danger and harm, so it is understandable that girls may be fearful and hesitant about the idea of a monthly bleed.  Rather than the haemorrhaging they may be imagining, the average amount of blood lost during a period is similar to 1-2 egg cups in total (although it can look much more when seen on a pad or in the loo).  This level of bleeding is entirely harmless as long as she is eating a well-balanced diet and it is helpful to reassure her of that (vegetarians may need additional iron and b12 support).

Many girls may have heard negative stories surrounding periods, particularly if their mum or older sisters have had bad experiences, and so they may start off with a negative perception of how life will be impacted.  It is important for her to know that most women do not have problem periods and when they do, it is more common for it to occur later on in life, so she is likely to be absolutely fine and be able to carry on with all her normal activities, sport and school in just the same way.

  1. Get practical

  • There are a wealth of options out there for girls and women to manage periods from pads to tampons to period pants and menstrual cups.Whichever she chooses is a matter of personal choice and comfort.
  • Period pants are a game changer for young girls (and women) I think. Very easy to use, reliable and odourless. They look just like normal underwear but have a high absorbency layer sewn into them.You may need to try different brands at first to find one that balances absorbancy with a comfortable fit but some brands claim to absorb the same amount of blood as 5 tampons, making them a really good choice for nighttime to save any 2am emergencies and groggy heads in the morning.  They are a bit more expensive than regular sanitary products initially, but they are designed to be washed after use are said to last between 6-24 months. They even come in swimwear.
  • Pads are also an easy go-to option for girls that have just started their periods.Depending on how heavy their flow is, they may feel more comfortable changing a pad at school than having to change out of period pants and carry them around all day, so this is still a useful choice to have and probably one that mums are more comfortable with given we have probably used them at some point ourselves.
  • Whilst there may be cultural and religious reasons for avoiding tampons, there is no medical reason she can’t try this option if she feels comfortable to do so.Very sporty girls in particular may find this a more attractive option.  It is worth looking at the instructions and some female anatomy diagrams together so that she knows where the vaginal opening is. You can also use a small mirror so that she can see for herself.  Remember the vagina slopes gently backwards so the tampon needs to be directed up and slightly back.  She might find starting off with tampons with applicators easiest.  It is important she remembers to change her tampons regularly; it isn’t uncommon for one to be forgotten and whilst this doesn’t usually pose a health risk, there is a small risk of toxic shock syndrome. Less mature girls may find grappling with all of this a bit much or too painful. If so, she can always try again at a later date.
  • Menstrual cups require practice to get used to even for adults and are likely to be an ambitious starting choice for most young girls.Having said that, there is no reason why a mature, motivated girl can’t try them.
  • Having to deal with leaking or periods starting unexpectedly is also something that every woman will have to deal with and being well prepared can help prevent any embarrassing episodes.It might be helpful to have a small “period pack” kept in her school or sports bag that has a spare pair of underwear, a few sanitary pads, tampons or period pants depending on what she is using and some baby wipes.  Teaching her how to fashion a temporary “pad” from tissue paper is also worth doing in case she is ever caught out completely.
  1. When to worry

  • The average age for periods starting is around 12 but it is not uncommon for it to follow a familial pattern; girls of mothers that started their periods late often follow a similar pattern but do see a doctor if her periods haven’t started by 15 (or 13 if there are no signs of puberty at all). Periods starting before the age of 8 should always prompt a doctor’s visit.
  • It is completely normal for periods to be irregular and less frequent for the first few years after they start, as the body’s hormonal control mechanisms are not fully mature. They usually become more regular over time.  However, if her period does not come for 6 months (or 3 if they have previously been regular), seeing a doctor is advisable.
  • Every girl will have different perceptions of what constitutes a heavy flow, but if she experiences significant leaking and or needs to change an average absorbancy pad or tampon more than once every few hours, then we need to make sure there isn’t an underlying medical reason for that, so please bring her in.In addition, and especially for the non-meat eaters, if you notice her becoming more lethargic and fatigued, she should be checked for iron deficiency.
  • It isn’t uncommon to experience cramping pains in the first day or two of the period. She may also experience bloating, a change in her stools, fatigue and mood changes.  I would usually expect simple pain relief (paracetamol or an anti-inflammatory medication) during this time to help with the physical symptoms and allow her to be relatively normal in terms of her activities.  Anything more than this warrants a doctor’s visit.

Key take aways:

  • Don’t be scared; this is a normal part of growing up and most girls manage perfectly well.
  • Be prepared; start having the chat about periods before they start, and once they do, make sure she is armed with everything she needs with spares in every bag.

Each girl and woman are different and so periods will also vary in lengths, timings, intervals and flows.  But if something doesn’t seem right, do seek advice from her doctor. 

Dr Natalie Hutchins is a Family doctor based in Osler Health Star Vista clinic. Dr Hutchins has a background in obstetrics and gynaecology and is known for her support in women’s health.
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