Menstruation usually begins around 11 years of age, but there is a wide variation in this, and anytime between 9-14 years is normal. If the onset of menses is delayed beyond this, examination and tests of the girl are required to confirm that there is no problem.
Initially, the periods can be very irregular and may not become regular up to 12 – 18 months of starting. This is due to the immaturity of the hormone axis which is normal. Gradually the menses will normalize, and the girl will bleed for 3 – 5 days every 28-30 days, which is the normal cycle. Too heavy bleeding during menses needs to check and Treatment for Heavy Periods as it may be a sign of a bleeding disorder or hormonal problem and can result in anaemia and weakness.
Menstrual hygiene is very important and must be taught to all young girls. Frequent baths during the periods, changing pads frequently, and disposing of the pads hygienically are necessary. Even today, there are many myths about menstruation like not eating a pickle, not entering the kitchen, taking total rest during this time, etc., all of which are illogical.
The adolescent girl is going through many hormonal changes in her body, which reflect in her physical, mental, and emotional state. Mood changes, irritability, and emotional swings are related as much to hormones as to the environment.
The family’s attitude towards menstruation will help her deal with it for the rest of her life. If it is treated as dirty, unclean, and isolated, she will have a negative response to menses forever. If it is treated as a wonderful process of growing up or maturing and having the amazing ability to bear children later, she will treat it positively, and it has been shown that these girls get much lesser pain and discomfort during menses as well as less premenstrual syndrome (PMS).
During the teenage years, many girls experience PMS. This may cause bloating, breast pain, depression, and irritability before menses, and the symptoms disappear after the periods. This is perfectly normal. The restriction of salt, refined flour, caffeine, chocolates, and light exercise during this time helps relieve symptoms. Also, adding calcium, B-complex, primrose oil, and such supplements may help reduce symptoms. Occasionally, hormone treatment is required in severe cases besides the usual Treatment for Irregular Periods.
Painful periods (dysmenorrhoea) are another common problem in teenagers, and many girls miss school and college because of it. This is usually due to excessive local production of prostaglandins and can be reduced by light exercise, hot showers, and anti-prostaglandin tablets taken at the onset of menses. In some girls, regular hormonal pills have to be given if there is severe pain.
Often during the growing years, there is a variation in both breasts, and size, which causes immense worry to the girl. This variation is common and may sort itself out once full growth is achieved, or once in a while, the discrepancy remains until adulthood. This has to be managed by wearing an unsuitable-padded bra or later by surgery, and there are no creams or medicines, which can help this.
There are many myths associated with menstruation and growing up, and proper sex educationand counseling or a meeting with a good gynecologist should be a part of growing up.
(Dr. Rishma Pai, Consultant gynaecologist & infertility specialist attached to Jaslok, Lilavati & Hinduja Healthcare Khar, Mumbai)
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