Puberty and Periods
Frequently asked Questions
How do I know if puberty has started?
The first sign of puberty in a young girl is breast development. The average age of breast development is 10, though some girls develop later and some develop earlier.
Puberty is a process. After breast development starts, some changes involve pubic hair and underarm hair growth, growth spurts, and her first period.
How old will my daughter be when she has her first period?
The average age of menarche (when a girl gets her first period) in the United States is about 12 and a half. A girl’s first period is two years after breast development begins. If breast development starts earlier, she may start her period earlier. If breast development is later, she may start her period later. The whole process varies from girl to girl.
Will my daughter grow taller after she starts her period?
A girl’s most significant growth spurt is typically just before starting her period. A girl may grow slightly after starting her period, but her major growth spurt is finished before the first period.
Feeling pain before or during your menstrual period is very common. More than half of women and girls with periods have some pain for 1 to 2 days each month.
Symptoms related to painful periods can include:
- Muscle cramps in your lower belly or back
If pain during your period is severe, you also may have trouble sleeping.
What causes period pain?
During your period, your uterus contracts. Your uterus also releases natural chemicals called prostaglandins. These chemicals can cause cramps.
Period pain also can be caused by medical conditions, including
- Cysts in the ovaries
Period pain caused by a medical condition may worsen over time.
When should I see a doctor about period pain?
Whether your period pain is mild or severe, you can ask your obstetrician-gynecologist (ob-gyn); or other health care professional for help. Period pain can cause you to miss school or work, or it can disrupt your everyday activities. It is essential to get help if your pain is severe, feels worse than usual, or makes your life hard every month.
What is a menstrual period?
When puberty begins, your brain signals your body to produce hormones. Some of these hormones prepare your body each month for a possible pregnancy. This is called the menstrual cycle. Hormones cause the uterus lining to become thicker with extra blood and tissue. One of your ovaries then releases an egg. This is called ovulation. The egg moves down one of the two fallopian tubes toward the uterus.
If the egg is not fertilized with a man’s sperm, pregnancy does not occur. The uterus lining breaks down and flows out of the body through your vagina. The release of blood and tissue from the lining of your uterus is your menstrual period (also called “your period”).
Most girls start their periods between 12 and 13 years, but some start earlier or later. When you first start having your period, it may last only a few days. Your first few periods may be very light. You may only see a few spots of reddish-brown blood. Anywhere from 2 to 7 days is normal.
A menstrual cycle is counted from the first day of bleeding in one month to the first day of bleeding in the next month. The average menstrual cycle is about 28 days, but 21–45 days cycles are also standard. It may take six years or more after your period starts for your cycle to get regular.
Personal Care Product Types
What are personal care products available for me during my menstrual period?
Pads are used to soak up the menstrual flow. Tampons and menstrual cups catch the flow from inside your vagina. Pads, tampons, and menstrual cups can be used at different times. Some also can be used together.
How are pads used?
Pads are worn inside your underwear to collect your menstrual flow. They come in different sizes, styles, and thicknesses. Some have extra material on the sides called “wings” that fold over the edges of your underwear to help keep the pad in place and give better protection. A thinner, shorter pad version is a “panty liner.” Some girls wear panty liners on the last days of their periods when the flow is light or when they think their periods will come.
Change your pad at least every 4–8 hours or whenever it seems full or feels wet and uncomfortable. Some girls change their pads each time they urinate.
How are tampons used?
Some tampons have a plastic or cardboard applicator tube that helps slide the tampon. Some tampons do not have applicators and are inserted with just your fingers. A short string attached to the end of the tampon hangs out of your vagina to help you remove it later.
Like pads, tampons come in different sizes for heavier and lighter periods. The tampon package will tell you how much fluid it will absorb. A “super” tampon, for example, is thicker and is meant for heavy flow. A “slim” or “junior” tampon is slender and is intended for a lighter flow.
It would help if you changed your tampon at least every 4–8 hours. Leaving a tampon in for a long time has been linked to toxic shock syndrome. When your flow is heavier, you may need to change it more often.
What are menstrual cups?
Menstrual cups are made of plastic or rubber. They are inserted into the vagina to catch the menstrual flow. You remove and empty the cup every 8–12 hours. Some cups are used only once and thrown away. Others can be washed and reused.
Heavy and Abnormal Periods
When is a menstrual cycle not normal?
Menstrual cycles in teens often are irregular, especially in the first few years after they start. An irregular cycle means the number of days between your periods changes a lot from month to month. There may be a problem if:
- You are 15 or older and have never had a period
- It has been three years since your breasts developed, and you have never had a period
- You are 14 or older, have never had a period, and you have an eating disorder, exercise a lot, or have hirsutism (excessive body hair growth)
- Your periods were regular each month, and then they stopped being regular
- Your period comes more often than every 21 days or less often than every 45 days
- Your periods come more than 90 days apart, even for one cycle
- Your period lasts more than seven days
When is bleeding not normal?
Heavy bleeding is not normal and may need treatment if:
- You have to change your tampon or pad more than once every 1 to 2 hours
- Your period lasts more than seven days
- You or a family member have a problem with blood clotting
- You feel dizzy or faint
What causes abnormal periods?
Some causes of abnormal periods may include:
- Polycystic ovary syndrome (PCOS)
- Bleeding disorders
- Eating disorders or extreme exercise
- Sexually transmitted diseases (STIs)
- A growth in the uterus, such as a polyp
- Hormonal problems, such as a problem with ovulation or with the thyroid gland
If you have any concerns about your period, talk with your obstetrician-gynecologist (ob-gyn) or other healthcare professionals. You also should see your doctor if you have any of the signs of heavy bleeding or abnormal cycle length listed above.
What should I think about when choosing a birth control method?
To choose the proper birth control method for you, consider:
- How well it prevents pregnancy—Read Effectiveness of Birth Control Methods.
- How easy it is to use—Learn what is required for each method below.
- How easy it is to get—Some types of birth control require a prescription, and you have to see a health care professional or go to a clinic to get them.
- Whether it protects against STIs—If you are having sex, you also need to protect yourself from STIs.
If you have any health problems, some birth control methods may not be recommended if you have certain diseases or medical conditions. It would help if you talked with your health care professional about any possible risks and the safety of each method to find the best option for you.
A pelvic exam is not needed to get most forms of birth control, except for the intrauterine device (IUD), diaphragm, and cervical cap. (Read Pelvic Exams to learn more.) If you already have sex, you may need to have a pregnancy and STI test before birth control can be prescribed.
Having a Baby
Prenatal care is the health care you get while you are pregnant. It includes medical care, education, and counseling. The earlier you get prenatal care, the better your chances of a healthy pregnancy and baby.
At your first prenatal care visit, your health care professional will ask you many questions. You will be asked the date of the first day of your last menstrual period. Your health care professional uses this date to figure out how many weeks pregnant you are and estimate when your baby will be born (your due date). You will have a complete physical exam, which may include a pelvic exam. You also may have a urine test and some blood tests. You may be tested for certain sexually transmitted infections (STIs).
Do teens have any special pregnancy risks?
Pregnant teens are at higher risk of specific health problems (such as high blood pressure or anemia) than older, pregnant women. Pregnant teens are more likely to go into labor too early. This is called preterm birth. These risks are even more significant for teens younger than 15 years or those who do not get prenatal care.
Teens also are likely to have STIs. You may have an STI and not know it. If you have sex during pregnancy, you could get an STI. Using a latex condom can help prevent getting or spreading some STIs.
What should I know about breastfeeding?
Breastfeeding is the best way to feed your baby. Breast milk helps the baby resist diseases and allergies. Breastfeeding also is cheaper than bottle-feeding and may help you return to your prepregnancy weight more quickly. Breastfeeding is recommended for the first six months of the baby’s life, but breastfeeding only for a few weeks or months has health benefits for the baby.
When you go back to school or work, you can still feed your baby breast milk. You will need to get a breast pump to collect and store milk. Your workplace or school should have a place where you can do this.
When should I see my health care professional after I have the baby?
Plan to see your health care professional within the first three weeks after your baby is born (the postpartum period). During this visit, your health care professional will make sure you are healthy and talk about your future health needs. It would help if you also planned for a complete postpartum checkup no later than 12 weeks after birth.
A relationship is a connection between you and another person. It is how you get along, communicate, spend time together, and shared interests. Relationships can be healthy or unhealthy.
A healthy relationship includes:
- Good communication
You feel physically safe in a healthy relationship, and you are comfortable just being yourself. You have other friends and hobbies or interests, and you can enjoy being together and spending some time apart. You and the other person both want the relationship.
An unhealthy relationship is one where you do not feel respected. You may feel the other person is not being honest with you. Unhealthy relationships also may include the following:
- Control, such as making all the decisions or keeping you away from other people
- Physical abuse, such as pushing or grabbing
- Teasing that is mean or makes you feel bad
- Dramatic statements, like saying you cannot live without someone
- Pressure to do things you do not want to, including sex
In an unhealthy relationship, the other person may want to know where you are all the time. They may text or call you constantly, act jealous, or accuse you of flirting or cheating. They may criticize how you look or tell you how to dress and act. They may use social media to spread untrue information about you or make you feel uncomfortable. And they may act violently and threaten physical acts.
If you wonder if your relationship is healthy, text LOVEIS to 22522 or call the National Teen Dating Abuse Helpline at 866-331-9474 to talk with a counselor.
Why do doctors ask about relationships?
Doctors ask about relationships because they can have a major effect on a person’s physical, mental, and emotional health. For example, breaking up with someone can affect your mental and physical health. Having sex means you need to make choices about birth control and avoiding STIs. Unhealthy relationships also can affect your health.
If you talk honestly and openly with your doctor, they can help you understand if your relationship is healthy. And they can help get you the resources you need to stay healthy and safe.
Sex and Pregnancy
What should I think about when deciding to have sex?
Deciding to have sex can be difficult. You should make up your mind when the time is right for you. If you are not ready for sex, say so. If you think you are prepared to have sex or already having sex—even now and then—you should avoid pregnancy and sexually transmitted infections (STIs).
Thousands of teens get pregnant each year because they do not use birth control correctly or do not use it. Many teens are deciding to protect themselves from pregnancy and STIs, too.
How does pregnancy happen?
A woman has two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg into a fallopian tube. This is called ovulation. It usually happens about 12 to 14 days before menstruation (the menstrual period).
During sexual intercourse (sex), the man’s penis goes into the woman’s vagina. When a man ejaculates (“comes”), his penis releases semen containing millions of sperm. If this happens during sex, the semen is released into the vagina.
Sperm in the semen can swim up the cervix and into the uterus and the fallopian tubes. If a sperm meets an egg in the fallopian line, fertilization can occur by joining sperm. The fertilized egg then can travel to the uterus and attach to the lining. Once the fertilized egg has attached to the uterus lining, the woman becomes pregnant, even if it is her first time having sex.
An eating disorder changes the way you eat and think about food. It can become a severe illness that causes physical and emotional health problems. An eating disorder can become so concerned with food and weight that the disease takes over their lives.
What is anorexia?
Anorexia nervosa is dieting to an extreme. People who are anorexic feel they are fat even when they may be significantly underweight. They usually have an intense fear of being overweight. They may:
- Severely limit what they eat
- Diet nonstop
- Refuse to eat food that is not served in small portions
- Want to eat alone
- Exercise too much
People with anorexia go through many physical changes. They may:
- Lose a lot of weight and still think they are overweight
- Lose hair from their head
- Have skin that is dry, pale, and yellowed
Women and girls with anorexia may stop having menstrual periods.
What is bulimia?
People with bulimia nervosa binge eat and then purge the excess food. Binge eating means they eat large amounts of food in a short time. They may feel like they cannot control what they eat or how much they eat during a binge. Then they purge the excess food by forcing themselves to vomit. Or they do things to compensate for overeating, including taking laxatives, fasting, or exercising too much.
People with bulimia also go through physical changes. They may have:
- A constant sore throat
- Swollen salivary glands in the neck and jaw
- Worn tooth enamel and decaying teeth from stomach acid
- Acid reflux and intestinal problems
- Dehydration and an imbalance of the minerals needed to be healthy
What is a binge eating disorder?
A binge eating disorder is when a person eats a tremendous amount of food in a short period. They do this over and over again. They may eat when they are not hungry and to the point that they are not comfortable. Afterward, they may feel disgusted, depressed, or guilty.
People with binge eating disorders usually do not purge the way bulimia does. Binge eating disorder is the most common eating disorder in the United States.
What are other types of eating disorders?
There are many types of eating disorders. Each has unique symptoms. Other types of eating disorders include the following:
- Avoidant restrictive food intake disorder is when you limit what you overeat, but you’re not worried about weight gain. You may eat only a few foods or only food with certain textures.
- Pica—This is an urge to eat things that are not food, such as ice, soil, or paper. This disorder may be related to other health problems.
- Rumination disorder is when you bring food you’ve swallowed back up into your mouth. You may then re-chew or re-swallow the food or spit it out. A person with rumination disorder typically does this without effort and without feeling stressed or disgusted, unlike a person with bulimia who makes themselves vomit.
What should I do if I have an eating disorder?
If you have an eating disorder, it is essential to talk with a trusted adult or health care professional, such as an obstetrician-gynecologist (ob-gyn), right away. The sooner you ask for help, the better. Your health care professional may help you find a doctor who specializes in eating disorders or nutrition.
Teen Substance Abuse
Substance use includes drinking alcohol and smoking or chewing tobacco. It also includes using certain types of drugs, such as:
- E-cigarettes (vaping)
- Marijuana, including smoking, vaping, or eating (edibles)
- Inhalants (inhaling fumes from everyday household products, such as spray paints, markers, glues, and cleaning fluids)
- Illegal drugs, such as cocaine, crack, speed, heroin, LSD, ecstasy, and synthetic drugs like “bath salts.”
- Legal drugs with opioid-like effects, such as kratom
- Prescription medications, if you:
- Use them in a way your doctor did not prescribe
- Use a family member or friend’s medications, such as pills to help with pain or ADHD.
Why is substance use hazardous for teens?
Your brain goes through an intense period of development during your teen years. The last part of the brain to develop controls your judgment, emotions, impulse control, and decision making. Until this part of your brain is fully mature, you are more likely to be harmed by drug use. The brain typically continues maturing until your mid-20s.
This means that substance use can damage teen brains more than adult brains. For example, studies have shown that teens who use marijuana often may lose an IQ that does not come back, even if they quit later in life.
What substance use is illegal for teens?
There are many laws about substance use in the United States:
- Drinking alcohol is illegal until you are 21.
- Buying tobacco products, including e-cigarettes, is illegal until 21.
- Marijuana is legal in some states. In all states where marijuana is legal, you must be 21 or
older to have or use it. Marijuana is still illegal under federal law.
- Sharing prescription drugs is illegal. This includes taking pills prescribed for
your parents or another family member.
- Drugs like cocaine, heroin, and meth are illegal for everyone.
How can I get help with addiction?
If you need help to quit unhealthy substances, you can get counseling and treatment. Talk with your parents, teachers, school counselors, doctors, or other healthcare professionals.
Media and Body Image
Images of what the media believes are “ideal” women are everywhere—on TV, in movies, online, in magazines, in ads, and video games. You may begin to believe that these images show what is normal. But the weights and body types of women you see in the media are not standard. Only about 5% of American women have the genetics to make it possible to look like these images. For most people, trying to look like these images can be unhealthy. It can cause depression, eating disorders, and low self-esteem.
It’s hard not to compare how you look with these images. You may not like what you see in the mirror and look for ways to “fix” yourself. Diets, makeup, and clothes are sold to make women look more like the images they see in the media. Ads for these products may be designed to make you feel insecure. This is just a way to sell more products. It’s not the truth of how a woman should look. Understanding how the media works is an essential step in not letting these images control how you feel about yourself.
What should I do if people make comments about my body that make me feel bad or uncomfortable?
Sometimes friends and parents think they are helping when they make certain comments, but they aren’t. Often these comments can do more harm than good. You may need to change some things in your life to be healthy, but you don’t need to listen to everyone’s opinion about your body. Try responding to negative comments with these statements:
- “It hurts my feelings when you comment on my food/weight/body.”
- “I know you mean well, but I’d appreciate it if you would keep those thoughts to yourself.”
- “How nice. Thanks for sharing that.”
- “How would you feel if I said something like that? Your comments about my food/weight/body are not helpful.”
What are the warning signs of an unhealthy body image?
You may have an unhealthy body image if you:
- View yourself only in terms of how you look
- Compare how you look with people on TV or in magazines
- Use negative words to describe your body
- Get depressed or sad about how you look
- Constantly think about ways to improve your body or looks
What can I do to feel better about my body and be more confident?
The following may help you build confidence and maintain a healthy body image:
- Be aware of how the media affects how you think about yourself. Understanding that the media’s unrealistic standard of beauty will help you stop comparing yourself with something that is not real.
- Pay attention to how much media you consume every day. Take breaks from it.
- Understand that there is a wide range of normal body types.
- Eat a healthy diet and exercise regularly. Treating your body well will make you feel stronger and happier.
- Focus on achievement, not appearance. Find role models who do the same.
- Find friends who have similar values.
Healthy Female Athlete
Playing sports is a great way to get the exercise you need while practicing physical skills. It is suitable for both your body and your mind. It also gives you a chance to make friends, have fun, and compete. But even with all of these benefits, you should be aware of specific health problems that can come with being a female athlete.
What health problems should I know about if I play sports?
Injuries. Girls who play sports are very active at a time when their bodies are still growing and changing. You may be more likely to injure yourself because your body hasn’t finished developing yet.
Hormone changes. Intense physical activity can affect your hormone levels. Hormones are the chemical messengers in your body. Female hormones, like estrogen and progesterone, help regulate your menstrual period. Estrogen also is needed to help keep your bones strong. Changes in estrogen levels can affect your overall physical development, period, and bone health.
Changes in eating habits. Some girls who play sports develop an intense focus on their weight. There’s often a lot of pressure from your coach or parents to succeed if you play sports. You may feel a responsibility to your teammates. You may feel a need to be “perfect.” This type of thinking can put you at risk of developing bad eating habits called “disordered eating.”
What is the female athlete triad?
The female athlete triad refers to three problems that often are found together in girls who play sports:
- Weight loss or being underweight (often because of disordered eating)
- Irregular or missed periods
- Low bone mass (weakened bones)
Who can I talk to if I think that playing sports harms my health?
If you have any warning signs of the female athlete triad or other problems, you should talk to your parents and coach. You also should see your doctor.
Sometimes it is hard to talk to your parents or a coach. You may feel like you cannot change your behavior without disappointing them. It is OK to want to be a good athlete, but not at the expense of your health. Your parents and coach should understand this. Your long-term health and safety are most important.
You, your parents, coach, doctor, and a sports nutritionist can work together to develop a plan for you to stay healthy and keep playing sports.
What can I do to stay healthy as an athlete?
Ask your doctor what a healthy weight for you is, and don’t go below that weight. Eat enough calories and healthy foods. Know how to recognize disordered eating and get help if you start behaving this way. Pay close attention to your periods and tell your doctor if you notice changes.
Your First Gynecologic Visit
When should I have my first gynecologic visit?
An obstetrician-gynecologist (ob-gyn) is a doctor who specializes in women’s health care. Girls should have their first gynecologic visit between 13 years and 15 years.
What should I expect at the first gynecologic visit?
The first visit may be just a talk between you and your doctor. You can find out what to expect at future visits and get information about how to stay healthy. You also may have specific exams.
Your doctor may ask a lot of questions about you and your family. Some may seem personal, such as questions about your menstrual period or sexual activities (including vaginal, oral, or anal sex). If you are concerned about confidentiality, you and your doctor should talk about it before answering any questions. Much of the information you share can be kept confidential.
What exams are performed?
You may have specific exams on the first visit. A nurse or family member may join you for any part of the exam if you choose. Most often, these exams are performed:
- General physical exam
- External genital exam
You usually do not need to have a pelvic exam at the first visit unless you have problems, such as abnormal bleeding or pain. If you are sexually active, you may have tests for certain sexually transmitted infections (STIs). Most of the tests that teens need can be done by the doctor with a urine sample. You also may have certain vaccinations.
What happens during an external genital exam?
In this exam, the doctor looks at the vulva. He or she may give you a mirror so that you can look at the vulva as well. This exam is a good way to learn about your body and the names for each part.
What are the pelvic exam and Pap test?
Even though you probably will not have a pelvic exam, you should know. Another test you will have later (at age 21) is a Pap test. This test checks for abnormal changes in the cervix that could lead to cancer.
The pelvic exam has three parts:
- Looking at the vulva
- Looking at the vagina and cervix with a speculum
- Checking the internal organs with a gloved hand
The doctor will use a speculum to look at your vagina and cervix. When you have a Pap test, a sample of cells is taken from your cervix with a small brush.
The doctor will place one or two gloved, lubricated fingers into the vagina and up to the cervix to check your internal organs. The other hand will press on the abdomen from the outside.
Celebration Obstetrics & Gynecology
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