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 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 upto 12 – 18 months of starting. This is due to immaturity of the hormone axis and is normal. Too heavy bleeding during menses needs check up and treatment as it may be a sign of a bleeding disorder or hormonal problem and can result in anemia and weakness. Gradually the menses will normalize and the girl will bleed for 3 – 5 days every 28-30 days, which is the normal cycle.
Menstrual hygiene is very important and must be taught to all young girls. Frequent baths during the periods, changing pads frequently, disposing off the pads hygienically is absolutely necessary. Even today, there are lots of myths about menstruation like not eating pickle, not entering the kitchen, taking total rest during this time etc., all of which are illogical.
The adolescent girl is going through a lot of hormonal changes in her body which reflect in her physical, mental and emotional state. Mood changes, irritability, emotional swings are related as much to hormones as to environment. The attitude of the family towards menstruation will help her deal with it for the rest of her life. If it is treated as dirty, unclean and she is 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 prior to menses and the symptoms disappear after the periods. This is perfectly normal and restriction of salt, refined flour, caffeine and chocolates alongwith light exercise during this time helps relieve symptoms. Also addition of calcium, B-complex, primrose oil and such supplements may help reduce symptoms. Occasionally, hormone treatment is required in severe cases. Painful periods (dysmennorhoea) is another common problem in teenagers and many girls miss school and college because of it. This is usually due to excessive local production of prostaglandin’s and can be reduced by light exercise, hot showers and antiprostaglandin 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 the size of both breasts and this causes immense worry to the girl. This variation is common, may sort itself out once full growth is achieved or once in a while the discrepancy may remain till adulthood. This has to be managed by wearing a suitability-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 education and counseling or a meeting with a good gynaecologist should be a part of growing up.