Adolescence and the Menstrual Cycle
Got teenage girls at home? Are they changing physically? Are they asking you questions you have no idea how to answer? Do they understand what’s going on? Do you?
Among the many issues that might drive some parents crazy about teenagers, menstruation is just one. With all the social, academic, and physical pressures exerted on our children, the menstrual cycle may not be top on your list of topics to cover. But, like it or not, at some point that dreaded first period will happen. And, after she talks to her friends and gets a lot of incorrect (often scary) information, she’s going to come to you!
On average, girls will start menstruating between the ages of 12 and 13. This is actually the last stage of puberty (or “sexual maturation”): Thelarche (breast development) usually starts first, anywhere from ages 8 to 12, followed by Adrenarche (pubic hair growth) and a growth spurt (there is some variation in the order of events). All of these processes are set into motion by a complex interaction of chemicals from the brain with hormones produced by the ovaries (known as the “Hypothalamic-Pituitary-Ovarian Axis”, or HPO), which then exert their effects on their targets: breasts, genitals, and bones, among others. (How’s that for a quick summary of multiple textbook chapters!)
At first, as would be expected for a new system recently set into motion, there is some element of chaos. To put it simply, the brain doesn’t always know what the ovaries and uterus are doing, and vice versa. This is known as immaturity of the HPO axis, and results in irregularities of the menstrual cycle. The important idea to remember is that this irregularity of menstruation is entirely normal. That said, the question I hear most often as it pertains to my patients’ daughters is: When do I need to bring her to see you?
Not all teenagers need to see a gynecologist. If everything seems normal, the first visit is usually recommended sometime after age 18, but no later than age 21. Here are just a few reasons you should consider bringing her in earlier:
- Painful menstrual cycles – if over-the-counter pain medications aren’t helping, she probably needs to be evaluated.
- Heavy or Frequent bleeding (what a mentor of mine once called the “1-10-20 rule”) – If she is filling up more than 1 pad or tampon per hour, bleeding longer than 10 days each cycle, or begins her period more often than every 20 days (several cycles in a row), bring her in. Blood loss in these instances may be excessive, and there are some simple tests to perform to determine if this is the case.
- Absence of menstrual bleeding for more than 3 months after previously regular cycles.
- If she has not started menstruating at all by age 17 (in otherwise normally developing girls), or by age 14 if there is also no development in other areas (breast or pubic hair, for example) – several genetic and medical conditions can cause this, and should be evaluated.
Of course, any questions you feel unable to answer (or are simply too uncomfortable to address) may be directed to your gynecologist. Although some teenagers will be uncomfortable with the idea of speaking to a stranger about such personal issues, with encouragement from supportive parents, many are thankful to finally get the right information.