Adolescent Menstrual Issues

Adolescent Menstrual Issues

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Summary

Menstrual periods are part of a monthly cycle your daughter will experience that enables her to reproduce. On average, girls experience their first menstrual period between the ages of 12 and 13, but every girl’s body changes at a different rate. Some girls start menstruating as early as age 10, others not until 15. Most girls start their menstrual periods by age 16.

Expanded Overview

Menstrual cycles last an average of 28 days, but may range anywhere from 21 to 37 days, and periods can last from two days to a week. There are many normal variations in the cycle. You should make an appointment with your daughter’s doctor if:

  • Her period has not started by age 15 (primary amenorrhea)
  • Her periods consistently last longer than a week
  • She experiences excessive bleeding or periods lasting more than seven days, using more than eight pads or tampons per day
  • She has not had a period for three months (secondary amenorrhea)
  • She experiences bleeding between periods
  • She experiences severe cramps/pain before or during her period

Symptoms

Girls and young women typically experience physical and emotional symptoms right before – or during – their periods. These symptoms – caused by changes in a girls’ hormone levels – are normal. They include:

It’s important for your daughter to see her doctor if she is experiencing significant menstrual irregularities, heavy bleeding, or very painful periods known as dysmenorrhea.

If your daughter is experiencing  very painful periods, or dysmenorrhea, her symptoms may include:

If your daughter is experiencing menstrual irregularities, her symptoms may include:

  • Periods that are too far apart, instead of once a month (>37 days between day 1 of one period to day 1 of the next)
  • Periods that are too close together (every two or three weeks)
  • No period by age 15
  • Periods that stop occurring for several months
  • Heavy periods, or prolonged bleeding
  • Painful periods

Tests and Diagnosis

There are two types of dysmenorrhea (painful periods):

  • Primary dysmenorrhea, the most common form, presents as painful cramping in the lower abdomen starting one or two days before a period and lasting two to four days.
  • Secondary dysmenorrhea presents as painful cramps that occur as a result of a medical condition, like endometriosis, or a uterine shape abnormality.

Painful periods may be caused by:

  • Endometriosis – a condition in which uterine tissue grows elsewhere in the body – may cause heavy, painful periods.
  • Pelvic inflammatory disease (PID) – an infection of the reproductive organs.
  • Uterine fibroids, adenomyosis or polyps – non-cancerous growths in the uterus – may cause painful periods, heavy bleeding, or bleeding between periods. This category is much more common in adult women and rarely seen in adolescence.

If your daughter has painful periods, her doctor will first take a medical history and conduct a physical and abdominal exam. In some cases, she may need a pelvic exam. The doctor may ask your daughter to keep a record of her period pain – when and where it occurs, how long it lasts, and how it’s relieved.

If your daughter is experiencing menstrual irregularities, possible causes include:

If your daughter has irregular periods, her doctor will first ask your daughter what’s normal for her menstrual period, and what types of irregularities she’s experiencing. The doctor will then conduct a physical and abdominal exam, and –if necessary – a pelvic exam.

If your daughter is sexually active, the doctor will give her a pregnancy test and screen her for infections.

Treatment

For painful periods, treatment strategies include:

  • Over-the-counter or prescription anti-inflammatory medications for cramps
  • Oral contraceptives (birth control pills), which can help regulate periods and reduce pain
  • Heating pad or warm baths
  • Exercise
  • Healthy diet
  • In the rare instance of a uterine shape abnormality, surgery may be indicated to correct this

For irregular periods, treatment strategies include:

  • Hormone therapy or oral contraceptives (birth control pills) to help regulate the menstrual cycle
  • Regular pelvic exams to ensure underlying problems are treated as soon as possible

For heavy periods, treatment strategies may include:

  • Blood tests to rule out anemia or other hormonal disorders
  • Pelvic ultrasound examination
  • Trial of a hormonal contraception method (oral, injection, vaginal ring, arm implant or intra-uterine device)
  • Referral to one of our combined gynecology/hematology clinics to rule out an inherited bleeding disorder

FAQs

At what age should my daughter have her first period?

On average, girls experience their first menstrual period between the ages of 12 and 13, but every girl’s body changes at a different rate. Some girls start menstruating as early as age 10, others not until 15. Most girls start their menstrual periods by age 16.

What’s normal for my daughter’s cycle?

Menstrual cycles last an average of 28 days, but may range anywhere from 21 to 37 days, and periods can last from two days to a week. There are many normal variations in the cycle. Many girls also experience premenstrual symptoms like cramps, bloating, headache, mood swings, fatigue, acne, and food cravings.

When should I consult my daughter’s doctor?

Make an appointment with the doctor if her period has not started by age 15; her periods consistently last longer than a week; she experiences excessive bleeding or periods lasting more than seven days, or uses more than eight pads or tampons per day; she has not had a period for three months; she experiences bleeding between periods; or she experiences severe cramps/pain before or during her period.

What’s causing my daughter’s heavy or painful periods?

Heavy or painful periods could be normal for your daughter, or they could signal a medical condition like endometriosis or uterine shape abnormality.

What’s causing my daughter to have absent or irregular periods?

Missed or irregular periods can be caused by polycystic ovarian syndrome (PCOS), premature ovarian insufficiency (POI), eating disorders, extreme weight loss, or excessive exercise.

Resources

 

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