Menstruation: A Primer for Mothers and Daughters

Whether you’ve recently started menstruating or you’ve had your period for a while, the following article is for you. And your mother, if she happens to see it before you do!  

Dr. Aimee Morrison, a specialist in pediatric and adolescent gynecology and an Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medicine, has plenty to say about menstruation—a process that affects virtually every girl and woman on the planet but can feel mysterious and even troubling, especially at first. 

So what, exactly, is menstruation? It’s typically defined as the monthly shedding of the lining of the uterus, which is composed of blood and tissue from that organ. Dr. Morrison further defines it as “the final stage of puberty, during which a girl’s brain, ovaries and uterus are in sync and ‘talk’ to each other.” 

A girl’s first menstrual period, called menarche, marks the start of a journey toward adult womanhood. Wherever you are on that journey, Dr. Morrison’s insights and advice promise to be helpful, especially when it comes to improving a girl’s quality of life by making her periods more predictable, lighter and less crampy. 

At what age does menstruation typically start? 

In the U.S., the average age of menarche is 12, she says, but it can start as early as age 8 or as late as 15 and still be within the normal range. 

What is the menstrual cycle? 

The menstrual cycle comprises the days when you you’re actually menstruating and the days between periods—usually about 4 weeks in all. But, Dr. Morrison says, “a girl’s cycle can be irregular for the first couple of years, during which the conversation I mentioned earlier between the brain, ovaries and uterus is still sorting itself out. So don’t worry if every once in a while your period comes later than expected, or if you skip one altogether.” 

What may cause a girl to skip her period?  

Don’t hesitate to see your gynecologist, she says, if you’re experiencing severe pain during your period. 

What about heavy periods? Are these normal? 

They may be “normal” in the sense of “common,” but if left to their own devices, they can lead to anemia (low blood count), fatigue and low energy. What’s more, heavy bleeding can be the first sign of a bleeding disorder, so if you’re bleeding heavily during your period, that’s another reason to make an appointment with your gynecologist. 

Medications to ease your symptoms 

Several hormonal medications are available, and these have been proven effective in regulating a girl’s period and making it lighter and less painful. Although they’re used for birth control in adult women, “we can prescribe them for the purpose of managing menstruation.” The most common hormonal medications come in the form of a patch or pill. 

Another medication—one that isn’t used for birth control—is called tranexemic acid. It will make your period lighter, but it won’t help with pain or predictability. 

And finally, there’s an IUD (intrauterine device) that releases hormones locally to the uterus. 

What is PMS? 

If you find yourself feeling hopeless or experiencing crying jags a week before or during your period, you may be suffering from PMS, or pre-menstrual syndrome. The severe form of PMS is called PMDD, which stands for pre-menstrual dysphoric disorder. PMDD can erode a girl’s quality of life, so if your emotional symptoms are truly destabilizing, seek help from your doctor or from a mental health provider, Dr. Morrison advises. 

Pads vs. tampons 

Citing a wealth of menstrual products on the market, Dr. Morrison considers all of them effective and appropriate for use by girls and women at every age and stage—including tampons. 

“There’s a long-standing myth that tampons can affect a girl’s ‘virginity,’” she says, stressing the word “myth.” Her best advice? Change them regularly, and stay clean and dry. Most important of all, don’t leave them in your vagina longer than 12 hours. Otherwise, you’ll be at risk for toxic shock syndrome, a rare but serious condition caused by certain strains of bacteria. Toxic shock may result from leaving a tampon in the vagina too long—especially the super-absorbent type of tampon. That risk can be mitigated easily by disposing of the tampon within the recommended time frame and replacing it with a fresh one. 

Pads are a fine alternative to tampons, she says. As well, you may decide to try one of the newer menstrual products, such as period underwear, which absorbs period blood, or a period bathing suit! Or you may opt for a period cup or disc. A menstrual cup may be easier to insert and remove than a disc, but If you’re a “beginner,” you may wish to try out various products and see which you prefer, she says.  

Menstrual hygiene 

When it comes to your period, hygiene is all about cleanliness. But, she says, don’t bother with expensive and unnecessary “feminine hygiene” products. The best way to keep clean? A plain warm water bath. That’s because the vagina is self-cleaning. “It’s home to both ‘good’ and ‘bad’ bacteria, and it ‘knows’ how to regulate and balance them.” 

Plus a warm bath is relaxing—obviously!—and can help ease cramping along with other symptoms. 

Changing and disposing of pads and tampons is another critical piece of menstrual hygiene. To learn the best ways to do that, talk to your mother, sister or friends. And remember: practice makes perfect! 

If you’re a beginner, or if you’re the parent of one, make an appointment with a specialist in adolescent gynecology at Weill Cornell Medicine here.