Menstruation in Adolescents: The Importance of Using Menses as a Vital Sign
Jul 03, 2019
Adolescence is a time of many new things – including puberty changes and the onset of menstruation. A first period can be an exciting experience, but one that may cause some anxiety for young women and their caregivers.
Talking about periods may be difficult, or even embarrassing, for young women. Education about what is normal helps alleviate any anxiety and gives guidelines for when young women and their caregivers should seek care from a reproductive healthcare provider if menses are not falling within normal parameters.
It’s important that young women and their caregivers understand what to expect of a first menstrual period and ongoing periods. Identifying abnormal periods may help identify and manage potential health concerns as young women move into adulthood. Young women should also be educated on what types of menstrual products exist (i.e. pads, tampons, menstrual cups); and how to use menstrual products appropriately.
Young women will likely begin to menstruate 2-3 years after breast development (“breast budding”) has started. The average age of the first period is between 12-13 years. Most women bleed for 2-7 days during their menses. When young women first start menses, the brain and ovaries are learning how to communicate with each other and cycle length may vary. The majority of cycles will be within the range of 21-45 days. By the third year after the first period, most cycles are 21-34 days long.
Once a young women starts having periods, she should keep a menstrual diary/calendar noting the following:
When periods occur
How many days they last
How heavy the flow is (i.e. how often you change pads and/or tampons)
If you have any pain with periods
Any other period concerns (i.e. mood changes, nausea/vomiting, headaches)
There are several smartphone/smart device apps that can help track menses.
Having a regular periods indicates your body is healthy – so it’s important to notify your provider if periods are not occurring regularly or at all.
Young women and their caregivers should contact a healthcare provider – their primary care provider or a reproductive healthcare provider – if they experience any of the following:
Periods that have not started within 3 years of breast development
Periods that have not started by 14 years of age with signs of excess hair growth (hirsutism)
Periods that have not started by 14 years of age in patients with excessive exercise or an eating disorder
Periods that have not started by 15 years of age
Periods that occur more frequently than every 21 days or less frequently than every 45 days
Periods that occur 90 days apart even for one cycle
Periods that last more than 7 days
Periods that require frequent pad or tampon changes (soaking more than one every 1-2 hours)
Periods that are heavy and are associated with a history of excessive bruising or bleeding or a family history of a bleeding disorder
Periods that are so painful it is interfering with normal activities or ability to attend school or ability to participate in extracurricular activities
Regularly talking with your healthcare provider about puberty and menstrual concerns is important. Empowering young women with education about menses and pubertal development will allow them to build confidence and actively participate in their own reproductive healthcare.
Kate McCracken, MD is a distinguished member of Nationwide Children’s Pediatric and Adolescent Gynecology team.
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