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Menstrual Problems

A girl's first period is a physical milestone and a sign that she's becoming a woman. But menstruation also can come with problems, like irregular periods or PMS. Most period problems are common and normal. But some might be a sign of something that needs medical care.

What Is Premenstrual Syndrome (PMS)?

A few symptoms, such as mild bloating or breast soreness, are common right before a girl's period. But girls with premenstrual syndrome (or PMS) have a wave of emotional and physical symptoms.

PMS symptoms include:

PMS is usually at its worst during the 4 days before a period. It tends to disappear 2 to 3 days after the period begins. PMS can happen at any time in women of childbearing age. Not all women get PMS, and some only get the worst symptoms when they're older or closer to menopause.

The exact cause of PMS is unknown. But it seems to happen because of changing hormone levels in the body and changing chemical levels in the brain. During the second half of the menstrual cycle, the amount of in the body increases. Then, about 7 days before the period starts, levels of both progesterone and start to drop.

Some girls' bodies seem to be more sensitive to these hormone changes than others. Talk to your daughter's doctor if her symptoms are severe or interfere with her normal activities.

What Are Period Cramps?

Many girls have belly cramps during the first few days of their periods. They're caused by prostaglandin, a chemical in the body that makes the smooth muscle in the uterus contract. These involuntary contractions can range from dull to sharp and intense.

The good news is that cramps usually only last a few days. Using heating pads can help soothe the pain. Over-the-counter ibuprofen (Advil, Motrin, or store brand) or naproxen (Aleve or store brand) given for 2 to 3 days as soon as a period begins also can help. Call your daughter's doctor if she has severe cramps that keep her home from school or from doing stuff with her friends. Also let the doctor know if the cramps do not improve with home treatment.

What Are Irregular Periods?

A girl's body usually does not develop a regular cycle until 2 to 3 years after she begins her periods. During that time, the body is adjusting to the hormones released in puberty. And what's "regular" varies from girl to girl. The typical cycle of an adult female is 28 days, but some are as short as 24 days and others are as long as 38.

Changing hormone levels might affect the length of a period. A girl's period may last a few days during one month and up to a week the next. She may skip months, get two periods very close together, or alternate between heavy and light bleeding from one month to another.

Let the doctor know if:

  • your daughter's period hasn't settled into a pattern after 3 years
  • her period is now irregular after she had several normal periods
  • her cycle is less than 24 days or more than 38 days
  • she goes 3 months without a period

What Is Delayed Menarche?

Most girls get their first period between the ages of 10 and 15, but some get it earlier and some later. The first period is known as menarche (MEN-ar-kee). If your daughter is a "late bloomer," it doesn't mean something is wrong.

Genetics plays a big role in determining when girls get their periods. Girls often start menstruating at about the same age at which their mothers or grandmothers did.

Let your daughter's doctor know if she hasn't gotten her period by age 15, or by 3 years after starting puberty, which begins with breast development.

Most period problems are harmless. But a few conditions can be more serious and need medical care. These include:

What Is Amenorrhea?

Amenorrhea (ay-men-uh-REE-uh) is the term doctors use for absence of periods. Girls who haven't started their periods by the time they are 15 may have primary amenorrhea. This is usually caused by a genetic problem, a hormone imbalance, or a problem with the way the reproductive organs developed.

Secondary amenorrhea is when a girl who had normal periods stops menstruating for more than 6 months or three of her usual cycles. Pregnancy is the most common cause of secondary amenorrhea. So a girl with skipped periods should have a pregnancy test.

Other things that can cause both kinds of amenorrhea include:

  • stress
  • significant weight loss or gain
  • anorexia (amenorrhea can be a sign that a girl is losing too much weight and may have anorexia)
  • stopping birth control pills
  • thyroid conditions
  • other conditions that can affect hormone levels

Exercising too much (often in sports like distance running, ballet, figure skating, or gymnastics) combined with a poor diet also can lead to amenorrhea. A girl may lose too much weight or not gain weight during key periods of growth. For this to happen, though, a girl would have to train hard for several hours a day, most days of the week, and not get enough calories, vitamins, and minerals.

What Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding (AUB) is when periods are very heavy, last much longer than normal, or don't come regularly. Abnormal bleeding is more than 1 or 2 days of a heavier-than-average flow. Girls who have AUB soak through at least a pad or tampon an hour for several hours in a row, have blood clots the size of a quarter or more, or have periods that are more than 7 days long. They may need to wear both a tampon and a pad at the same time, or may need to change tampons or pads overnight.

The most frequent cause of heavy bleeding is an imbalance between the amounts of estrogen and progesterone in the body. Because of this imbalance, the endometrium (en-doh-MEE-tree-um), which is the lining of the uterus, keeps building up. Then when the body gets rid of the endometrium during a period, the bleeding is very heavy.

Many girls have hormone imbalances during puberty, so lots of girls have heavy bleeding. But sometimes it's due to problems such as:

  • fibroids (benign growths) or polyps in the uterus
  • thyroid conditions
  • clotting disorders
  • swelling, irritation, or infection in the vagina or cervix

If your daughter has heavy periods or periods that last longer than 7 days, talk to her doctor. The doctor may do a pelvic exam, a Pap smear, blood tests, or an ultrasound. If doctors think heavy bleeding needs treatment, they will decide what to do based on what's causing the problem.

What Is Dysmenorrhea?

Dysmenorrhea (dis-meh-nuh-REE-uh) is the medical term for very painful periods. Primary dysmenorrhea is more common in teens than secondary dysmenorrhea.

  1. Primary dysmenorrhea is very common in teens. It isn't caused by a disease or other condition. Instead, the culprit is prostaglandin, the chemical behind cramps. Some prostaglandin can lead to mild cramps. But large amounts can cause nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. But these symptoms usually only last for a day or two.
  2. Secondary dysmenorrhea is pain caused by a physical condition, such as polyps or fibroids in the uterus, endometriosis, pelvic inflammatory disease (PID), or adenomyosis (when tissue that usually lines the uterus grows into the muscular wall of the uterus).

Having cramps for a day or two each month is common. But if your daughter's symptoms keep her from her normal activities or her cramps last for more than 3 days, tell her doctor.

What Is Endometriosis?

In endometriosis (en-doh-mee-tree-OH-siss), tissue normally found only in the uterus starts to grow outside the uterus — in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, dysmenorrhea, general pelvic pain, and lower back pain.

How Are Period Problems Treated?

Minor menstrual problems don't need specific medical care. For instance, over-the-counter pain relievers and a heating pad can help ease cramps.

For a more serious problem, the doctor will ask questions and do a physical exam. The doctor may do a pelvic exam, and might order blood tests, urine (pee) tests, or imaging tests like an ultrasound or CT scan.

Doctors often can remove growths such as polyps or fibroids, and treat endometriosis with medicines or surgery. The doctor may suggest hormone therapy with birth control pills or other hormone-containing medicines to manage a hormone imbalance. Conditions like clotting disorders or thyroid problems also may need treatment.

When Should I Call the Doctor?

Most period problems aren't cause for alarm. But some symptoms do call for a doctor visit. This is particularly true if a girl's normal cycle changes.

Take your daughter to her doctor if:

  • She hasn't started her period by the time she's 15 or her period hasn't become regular after 3 years of menstruating. The most likely cause is a hormone imbalance that may need treatment. But it also could be a sign of another medical problem.
  • She stops getting her period or it's irregular after it had been regular. Also let the doctor know if her cycle is less than 24 days or more than 38 days, or if she doesn't get a period for 3 months at any time after first beginning to menstruate.
  • She has heavy or long periods, especially if she gets her period often. In some cases, a lot of blood loss can cause iron-deficiency anemia. Also, heavy bleeding could be a sign of a growth in the uterus, a thyroid condition, an infection, or a blood-clotting problem.
  • She has very painful periods. Having cramps for a couple of days is normal. But if your daughter can't do her normal activities or has cramps for more than 3 days, let the doctor know. A medical problem, such as endometriosis, might be causing the pain.

How Can I Help My Daughter Feel Better?

When your daughter's having PMS or bad cramps, you can help make her more comfortable. Suggest that she:

  • Eat a balanced diet with lots of fresh fruit and vegetables.
  • Reduce her salt intake (salt can add to bloating) and skip the caffeine, which can make her jumpy and anxious.
  • Include foods with calcium, which may make PMS symptoms less severe.
  • Try over-the-counter pain relievers such acetaminophen (Tylenol, Panadol, or store brand), ibuprofen (Advil, Motrin, or store brand), or naproxen (Aleve or store brand) for cramps, headaches, or back pain.
  • Take a brisk walk or bike ride to relieve stress and aches.
  • Soak in a warm bath or put a heating pad on her belly, which may help her relax.

If your daughter's periods cause her great discomfort or interfere with her life, talk to her doctor. Sometimes, hormone treatment with birth control pills can help ease symptoms of uncomfortable periods.

Remind your daughter that most period problems are normal and may improve over time. And be understanding when she's cranky and unhappy. After all, no one's at her best all the time.

Date reviewed: October 2018