Mom & Daughter talking

The “Period” talk! What’s normal?

I’m the mother of two little boys. So while I won’t have “the period talk” at home, I talk about it at work. A whole lot!

Girls tend to drive themselves crazy about their periods.  Is it normal? Am I okay? Let’s be honest, these are questions all of us girls ask over the arc of our lives, from first periods to periods long gone.

I see girls and young women for all sorts of problems with their periods – usually, it’s too little bleeding or too much bleeding, and problems with cramps. Most girls don’t require the assistance of a subspecialist like myself, but still may wonder if the changes they experience during puberty are normal. If they are normal. So, let’s set the record straight about what to expect during that first year.

A series of intricate hormonal changes set the stage for a girl’s first period. Deep in her brain, her hypothalamus and pituitary become sensitive to certain signals and secrete chemical messages (or hormones) that instruct her ovaries to make another hormone called estrogen. As estrogen levels rise, the inside part of a girls uterus (the endometrium) thickens.  Ovaries also produce another hormone called progesterone. Progesterone actually helps stabilize the uterine lining. As the ovary cycles between estrogen and progesterone production, the uterine lining thickens and then is stabilized. When the lining gets too thick and is unstable, some areas may slough off.  Alternatively, when the levels of progesterone fall, the lining sloughs off.  These bleeding episodes are what we call “periods”.

Most girls will have their first period sometime between the ages of 11 and 13. It is helpful to know that most girls will not have regular cycles for at least a year. During that first year, most periods last 3 to 7 days and cycle every 21 to 45 days.  It would be uncommon to have a break of more than three months between periods at any time after periods start. Some girls don’t have much bleeding, and some have heavier bleeding. It would be unusual for a girl to need to use more than 6 pads or tampons per day. As well, cramps are unusual the first year of periods. I will write more about specific problems and when to see a doctor in future posts.

For your girls, prepare them well.   Help them have access to pads and tampons, and keep those lines of communication open. Talk to them about their bodies and the changes of puberty early and often, the best way you can. Don’t worry if you don’t understand the details or know specific terminology. That’s what your child’s pediatrician, the library, and the reputable sites on the internet are for.

Elise Berlan, MD
Elise DeVore Berlan, MD, MPH, is a member of the Section of Adolescent Health at Nationwide Children’s Hospital and an Assistant Professor of Clinical Pediatrics at The Ohio State University College of Medicine. She is also a wife and a mom to two young boys. Dr. Berlan loves to bike, travel and read. She is also interested in volunteer work and helped to start an international health charity called Medicine for Mali.

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