The first period is known as menarche, and it can be a confusing time for a teenager or a pre-teen. Since pubertal changes are associated with emotional changes in addition to physical ones, it is important for parents to keep their child abreast about the transformation, sexual health, menstrual hygieneetc.
According to Dr Geeth Monnappa, consultant, obstetrics and gynecology, Fortis hospital, Richmond Road, Bangalore, the sequence of pubertal changes is as follows: a girl will start to experience changes in her body from the age of 8 to 15. These changes occur in sequential order.
– Breast development/thelarche: Development of small breast buds under the nipple.
– Pubic and axillary hair (pubarche): Small fine hair growth in the armpits and pubic area noticed after the development of breast buds.
– Growth spurt: Growth spurt begins soon after. A girl attains most of her adult height by the time she gets her first period, although she may continue to grow until 16-20 years of age.
– First period/menarche: The above changes culminate in the first period/menarche, which is often regarded as a child’s official entry into adulthood.
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“A child can start developing breasts and axillary hair between 8-13 years of age. The age of puberty is influenced by genetics, nutrition, and socioeconomic conditions. Obese children often tend to attain puberty earlier than children with a normal BMI. Parents can expect their child to get her first period within 2-5 years of the appearance of a breast bud/axillary and pubic hair,” the doctor explains, adding that the absence of breast development and hair growth at 13 years of age needs further evaluation.
Similarly, the development of breasts and hair growth prior to the age of 8 requires a detailed work-up.
Parents need to educate their children about menstruation as soon as they notice changes in her body, what it means, the methods available for menstrual hygiene — sanitary pads, tampons and menstrual cups — along with their pros and cons. “Most importantly, they must let her know this is a normal phenomenon,” the doctor suggests.
What to expect in the first few years post the first period?
Dr Monnappa says the first period signifies activation and maturation of the hypothalamo-pituitary-ovarian axis (the nerve signals between the brain and the reproductive organs) that was dormant during childhood. A regular pattern sets in within five years of the first period.
Bleeding patterns that are normal during this phase:
* Duration: Up to 7 days
* Interval between periods: 21-45 days
* Change of pads/tampons: 3-6/day
“If a girl experiences heavy bleeding lasting more than 7 days or absence of periods for more than 90 days from her first period, she needs to be evaluated for thyroid disorders, PCOS and bleeding disorders. In 2-5 years, a normal adult pattern of menstrual cycle with an interval of 21-35 days sets in. Painful periods/dysmenorrhea is often a complaint. If it is incapacitating, requiring medication or one that is preventing her from doing regular activities, it needs to be evaluated,” she advises.
Sex education and HPV vaccine
Although most parents are uncomfortable, this is the right time to educate your child on body, sex, protection and pregnancy. “The first period could also be a gentle reminder for the HPV vaccine to protect them from cervical cancer. As the vaccine is most effective before the onset of sexual activity, it is recommended for girls between 9-26 years of age,” the doctor concludes.