|SSM Cardinal Glennon Children's Medical Center|
Talking to Your Child About Menstruation
Preparing for the First Period
The start of menstruation is a major event in a girl's life. Some girls greet those first drops of blood with joy or relief, while others feel bewildered and scared. Whatever the reaction, the arrival of the first period holds the same meaning for every girl: It's proof that she's becoming a woman.
On average, most girls start their periods when they're 12 or 13 years old (although some begin earlier or later). But if you wait until your daughter gets her period to talk to her about menstruation, that's too late.
So, how do you discuss menstruation and offer education, as well as guidance and support, before the big day arrives? Or, what do you tell your son? (Boys have questions, too.) Before you can discuss menstruation, it's important to have a good understanding of how the process works.
In the early 1900s, girls generally reached menarche (the medical term for the first period or the beginning of menstruation) at age 14 or 15. For a variety of reasons, including better nutrition, girls now usually start to menstruate between the ages of 10 and 16. But menstruation isn't just about having a period. It's a sign that a girl is physically capable of becoming pregnant.
During the menstrual cycle, hormones are released from different parts of the body to help control and prepare the body for pregnancy. That preparation begins when the ovaries (two oval-shaped organs that lie to the upper right and left of the uterus, or womb) produce the hormones estrogen and progesterone. These hormones trigger certain changes in the endometrium (the lining of the uterus). Then, other hormones from the pituitary gland stimulate the maturing and release of the egg, or ovum, from the ovary.
The release of the egg is called ovulation, and it occurs in the middle of the cycle — usually day 14 of a 28-day cycle, for example. From the ovary, the egg moves into one of the fallopian tubes (the two tubes that lead from the ovaries to the uterus).
If the egg is fertilized by sperm, the fertilized egg will take about 2 to 4 days to travel down the fallopian tube. It will then attach to the thick, blood-rich lining of the uterus. If it's not fertilized, the egg begins to fall apart, the estrogen and progesterone levels drop, and the uterine lining breaks down and is shed — this bleeding is what's known as a period.
A menstrual cycle lasts from the first day of one period to the first day of the next. The typical cycle of an adult female is 28 days, although some are as short as 22 days and others are as long as 45. Periods usually last about 5 days, although that can vary, too. During a period, a woman passes about 2-4 tablespoons (30-59 milliliters) of menstrual fluid.
For the first few years after menstruation begins, cycles are often irregular. They may be shorter (3 weeks) or longer (6 weeks), or a young woman may have only three or four periods a year. The absence of periods is called amenorrhea. A girl should see her doctor if she hasn't started menstruating by age 15, or 3 years after her first signs of puberty appeared.
So, how will you know when your daughter might start menstruating? You'll probably be able to see physical changes that signal she's getting close to starting. Breast development is usually the first sign that a girl has entered puberty. It's usually followed by the growth of some pubic hair.
About a year after breast development begins, most girls enter into a phase of rapid growth. They'll get taller and curvier, and their feet will grow. Then, about a year after the growth spurt begins and about 2 and a half years after breast development starts, the first period arrives.
Timing Is Everything
It's probably best to avoid "The Talk" about menstruation. Instead, try to spread it out into lots of smaller conversations — education about how the human body works should be continuous. Otherwise, too much importance is placed on a single discussion and the information can be overwhelming. Kids reaching puberty should already know what's going to happen to their bodies.
Even toddlers begin asking questions about their bodies, and parents should answer them honestly. But how specific you are with the details should depend on your child's maturity and ability to understand.
Throughout childhood, kids ask many questions and each is an opportunity for parents to advance their kids' knowledge. Doing so not only gives kids the information they need when they ask for it, but also lets them know that their parents are available for and comfortable with these discussions.
But you shouldn't necessarily wait for their questions to talk about puberty and menstruation. Ideally, by the time they're close to puberty, both girls and boys should have full knowledge of the changes that will take place in their bodies. Why? Kids really want to learn about most things from their parents. And you can be sure that they'll also hear their friends discuss these changes.
By providing kids with good information, parents will know that they're well-informed and able to sort out any misinformation. Kids can often make certain aspects of puberty — menstruation, especially — sound bad and scary; and if that's the only information kids, then that's what they'll believe.
It's also important for parents to paint the process of menstruation in a positive light. If a mother refers to her period as "the curse," her daughter might get a negative impression of the whole experience. Instead, mothers can explain that monthly periods are a natural and wonderful part of being a woman. After all, without them, women couldn't become mothers.
Explaining that everyone is different is also key. For example, your daughter may be concerned that her body is changing more quickly — or more slowly — than her friends' bodies.
In addition to understanding how menstruation works, girls need to be familiar with feminine-hygiene supplies (sanitary pads and tampons) and they should know that sometimes periods may cause cramps when the muscles of the uterus contract.
Another reason kids need to know about menstruation at an early age is that sexually active girls can get pregnant even before they start menstruating. Sometimes ovulation (the release of an egg from an ovary) can happen just before a girl is about to have her first period. This means that she can be fertile and become pregnant even though she hasn't yet menstruated.
Common Questions About Periods
Kids — both girls and boys — often have lots of questions about menstruation, such as:
Tips for Talking
Just as parents might be slightly embarrassed to talk with their children about menstruation, kids and teens may find it difficult to let mom and dad know their questions or concerns. If talking about menstruation is awkward for you, here are some ways to make discussions a little easier and more open:
It's important to tell kids the truth about menstruation in an age-appropriate way and to be comfortable with the accuracy of that information. Don't be put off by their questions — they're probably the same questions you had at that age, and now you can answer them.
Reviewed by: Steven Dowshen, MD