For as long as my daughters have followed me to the bathroom they have known that once a month I have a period. I have tempered my language around what must look like a blood bath to them but I have always wanted them to know that this happens to me....and that this one day will happen to them (but hopefully not the blood bath).
Thankfully, for them and me, at 10 years old and 7 years old they follow me to the toilet much less regularly, but the conversation around periods does not end. I want them to have the information, I did not have.
I am writing this blog for all those people who are choosing to give their children the information they might not have been given.
As always my messages are always open, so feel free to ask any questions I have not answered here.
Love
The Period Acupuncturist
Andrea Dewhurst
Let's start with the basics
I am a keen proponent of understanding the vocabulary for the reproductive system. Does it surprise you that what we commonly refer to as the "vagina", is the "vulva"?
The vulva comprises all the external structures that make up the female reproductive system.
Tip of the clitoris and clitoral hood
Labia majora and minora
Vaginal opening
Urethral opening
Internally the reproductive system is made up of the following:
Vagina
Cervix
Uterus
Fallopian tubes
Ovaries
DID YOU KNOW: when you are in the womb you develop ALL the eggs you will ever have in your lifetime, which is around 500,000. By the time they have reached puberty, you will have about 300,000.
When you reach puberty your reproductive system will be considered "mature" enough to reproduce.
When do teens typically get their period?
Girls reach puberty as early as 9, or as late as 17. There is no one-size-fits-all in how any or all of these changes will happen. Your breasts may develop at the same time as your friends. They may also not. You may not get your period at the same time.
These are the changes you might start to see before the period begins:
Breasts developing (thelarche stage): An increase in oestrogen causes the lactiferous duct system to develop, while an increase in progesterone causes the lobular alveoli at the ends of lactiferous ducts to increase in number [1]
Growth spurt
Bodyshape may change
Hair growth on the pubic region, underarms, and the rest of your body (pubarche): Approximately six months after thelarche begins, pubarche, or growth of pubic hair, will typically occur. Pubic hair initially appears light, sparse, and straight but will become coarse, thick, and dark throughout puberty. Approximately two years after pubarche, axillary hair will begin to grow, a secondary sexual characteristic mediated by testosterone. [1]
Sweating
Vaginal discharge: Clear to white vaginal discharge may also be seen before the onset of menarche [1]
Spots or acne may occur
First bleed (menarche): During puberty, the uterine endometrium undergoes cycles of proliferation and regression due to fluctuating plasma estradiol levels. This occurs until a point is reached when substantial growth occurs so that withdrawal of oestrogen results in the first menstruation (menarche). Plasma progesterone levels remain low until a rise occurs after menarche, indicating that ovulation has occurred. The first ovulation takes place approximately 6 to 9 months after menarche due to an immature positive feedback mechanism of oestrogen [1]
Typically, you will begin your periods about two years after your breasts start developing.
You should visit your primary healthcare provider if your periods start before 8 years old, or if you are over 16 years old.
Are irregular cycles a problem in teenagers?
Just as perimenopause heralds the beginning fluctuations of hormones, so does puberty. These fluctuations can show up in irregular cycles.
Girls who have just started their periods can have very irregular cycles as it takes the body a while to settle into its new routine of the rise and fall and feedback of oestrogen and progesterone.
Irregular cycles whilst not necessarily problematic can be annoying. You can be caught out by not knowing when your period is due to arrive, or even think it has finished only for it to start again a couple of days later. So, normal in that first year? Yes. Annoying? Also yes.
If irregular cycles continue for over 1 year then you would want to see your primary GP. However, your child will likely be prescribed hormonal birth control "to regulate" the period.
PLEASE NOTE: I am not against the use of hormonal birth control. For stopping unwanted pregnancies. But what I am less keen on them being handed out for menstrual-related concerns like irregular or heavy periods or acne. Because it is just a sticking plaster, without any investigation as to what is the root cause.
Of course, if your child is considering sex and they do not know when they are fertile I would investigate your options for safe sex.
But what is even a normal cycle? Many of us, because of hormonal contraception and the numbered pill packets, believe it is 28 days. However, this is not always the case.
I do think it is important though to understand what is normal, so you know when to seek advice when something feels abnormal:
How long is the menstrual cycle?: Bleeding which lasts between 4 to 6 days and with a cycle between 24 to 31 days
How much period blood should I lose? Between 10 to 80 ml
What day do I start counting my cycles from? Day one of your cycle starts on the first day of your period in full flow
What is discharge? Cervical discharge is great because it tells you about ovulation. Discharge which should be investigated by your GP is:
Thrush: white discharge with a potential “cottage cheese” appearance
Bacterial vaginosis: thin watery greyish discharge that might feel like it gushes out in some cases it could be yellowish or green
Cytolitic vaginosis: white creamy discharge. The discharge may be acidic and might irritate a cut
Should I have pain around my period? Pain is extremely common, but not necessarily normal. Pain:
that stops you from completing normal day-to-day activities
makes you vomit
requires copious medication and pain relief
Why is my daughter getting acne?
Teenage acne is thought to be triggered by increased levels of testosterone. It is thought that girls may get acne worse due to the fluctuations of all the hormones that their body experiences in a month.
The sebaceous glands are particularly sensitive to hormones and the increased levels of testosterone may cause the glands to produce much more sebum than the skin needs.
If you are considering how to help your child with their acne, caused by puberty, I would recommend Sam Farmer products which are specifically designed for teenage skin.
Some top tips include:
Washing your face daily, with a cleanser, especially after sweating
Even if you have oily skin don't forgo moisturiser
Try and avoid makeup which clogs the skin even further
Remember skin is so much more than the physical. It holds a very emotional element to it also, so please check in with children/people.
You can read my blog post about acupuncture for acne
If you have problematic skin please go to your GP and ask for a referral to a dermatologist.
In acupuncture, spots involve heat and we would suggest
Daily bowel movements
Drink plenty of water
Eat vegetables with every meal to flush out toxins
Avoid heating or inflammatory substances such as sugar, spices, garlic, and alcohol.
How long after pubic hair do periods start?
Pubic hair will start growing approximately 6 months after breasts start developing. So, approximately 18 months after pubic hair, your daughter may experience her first menarche.
My daughter hasn't started her periods yet, she is 13, but she is getting a lot more headaches. Is this normal?
Whilst not necessarily normal headaches during puberty can be common. Before puberty boys and girls are as likely as each other to experience headaches however headaches appear to become more prevalent in girls during and after puberty, with the fluctuations of hormones possibly at the epicentre.
However, genetics, stress, food, medications and any physical trauma must also be considered.
If you are concerned by the number of headaches your first port of call should be the GP. It will be helpful to take along a diary of headaches and any correlating information.
The NICE guidelines for children over 12 with headaches can be found here with treatment options from:
NSAIDs: please see my post here about the risk of NSAIDs with hormonal contraception and for more information you can go here
Paracetamol
Acupuncture
Oral triptan
Frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) on the day's migraine is expected
How can I help my daughter during their period?
According to a survey by Plan International UK, over half of girls will have missed a day or part of a day of schooling due to their period, and around one in three women suffer from heavy menstrual bleeding that can significantly impact their daily lives.
I think that you are investigating how to help them, is a wonderful start.
Believe them: if they are telling you they are in pain or their periods are really heavy then let's see how we can help them
Help them with cycle tracking. You can grab my free paper tracker here. They could ideally be tracking:
first day of bleed
last day of bleed
any vaginal discharge
any signs and symptoms such as mood changes, pain, headaches, energy
Make access to menstrual products freely available. School bag. Bathroom
Find out what the school offers in terms of menstrual products and their policies about leaving the classroom during lessons. Support your child by sending in a letter if you feel your child will be unfairly not allowed to leave lessons for period breaks.
Work out what menstrual products can best support them:
Period pants: these were a game changer for me as an adult (who remembers stuffing tissue paper in their pants when they were caught unawares at school) but they are pricey* and are also not the product for people who have very heavy periods.
Menstrual disc: holds the most volume of period blood but can be fiddly especially if you are at school and you don't have the luxury of time, space and access to handwashing in the same toilet cubicle
Pads: these are pretty good if you have heavy periods (and choose the correct absorbency) but they are not good for the environment and also not very discreet if you are trying to unwrap it and it is louder than rustling in the cinema with your popcorn!
Tampons: as pads, they are not as environmentally friendly as reusables and you need to make sure you have the right absorbency for your flow. You also need to make sure you are not leaving the tampon in for extended periods (ideally less than 8 hours).
Menstrual cups: similar to the discs in the pros and cons but do not hold as much period blood
*HERTS WASTE AWARE: if Hertfordshire is your county council you may be able to apply for a discount on their reusable period products. Check out their campaign here which will give you 15% off.
Can they get pregnant every day of their cycle?
Thankfully no. There are about 2-3 days of a menstrual cycle where someone is considered fertile, however in those first few years cycle tracking and understanding your body may not be their first thought when considering "fertility".
Getting to know their bodies and understanding how cervical mucus will change leading up to ovulation will give them invaluable life lessons for understanding themselves throughout their own adult life.
Krystal Kirton is a great resource when it comes to cervical mucus.
However, if they are considering sexual contact with a member of the opposite sex (who owns sperm) then you will need to discuss what forms of contraception they are planning on using.
Preventing pregnancy in teenagers
There are many contraceptives and it will take talking with your teenager to understand what they think will be the safest and best for them
The NHS has a great resource on the different types
Hormonal contraceptive pills: there is a vast array of pills which can be offered by your GP.
Condoms
IUD
Injection
Implant
Natural Cycles is a birth control app which works with an Apple Watch or an Oura ring
Our birth control is 93% effective with typical use and 98% with perfect use
My daughter's cramps are so bad, that she cannot go to school. What can I do?
Unfortunately, again this is common but not normal. Anything which inhibits normal life, such as school, should be taken to your primary healthcare provider.
Your daughter should be physically examined (and this may go beyond a pelvic examination) to preclude:
endometriosis
adenomyosis
fibroids
pelvic inflammatory disease
if they have had an IUD and this is pain after that insertion
If these are ruled out then the likely treatment will be:
In acupuncture, we would treat based on the
nature of the pain
when the pain occurs
where the pain occurs
if there are clots
And I have added some lifestyle advice based on that differential diagnosis in these pictures.
How and why different times of the month affect mood and productivity
In Chinese medicine and acupuncture we, rightly, view the cycle as a fluctuation. Not only our hormones but also our energy, our perspective, and the foods that would be beneficial.
In Maisie Hill's Book 'Period Power" she coins the cyclical changes alongside the seasonal changes.
Menstruation: Winter (when all the hormones are at their lowest ebb)
Follicular phase: Spring (when oestrogen begins to rise)
Ovulation: Summer (when all hormones are at their highest)
Luteal phase: Autumn (oestrogen begins to decline and progesterone takes over)
In the pictures below you will see how you can best support yourself during your cycle.
How does Chinese medicine view menarche?
The period from 14 to 20 years old is the second phase in the seven-year cycle for women.
This is considered the "fire" phase and it is characterized by emotionality, new connections, experimentation and the search for excitement.
The menstruation is referred to as the "red dragon" and like the mythical dragon its first stirring leaves turmoil in its wake.
There are often mood swings, changes in physical appearance and possible crises of identity.
The early years after menarche are considered the first of three "Golden Opportunities" to greatly influence a woman's life and constitution.
The first period should be treated as the rite of passage that it is. This is a great gift as it instils a sense of reverence for the power of her own body.
Here are the practices that an acupuncturist would encourage around menstruation:
Rest: during our menstruation, our hormones are at their lowest and there has been a loss of energy through the loss of blood. You should take the opportunity to turn inward, pamper yourself and conserve your energy.
Keep warm: keep legs, lower back and abdomen warm at all times. Wear socks and get hot stone massages. Abdominal massage should also be used.
Avoid cold drinks and food: no iced water, ice cream or salads. This is paramount in the UK climate
References: