Menstrual Problems

The teen years can be difficult — for both teens and parents. Physical changes during puberty can make adolescents feel awkward and unsure of themselves.

This is especially true for girls when it comes to menstruation. For a girl, getting her first period is a physical milestone and a sign of becoming a woman. But it also can be confusing and scary, particularly if she has certain problems, like irregular periods or premenstrual syndrome (PMS).

Common Menstrual Problems

Premenstrual Syndrome (PMS)

It’s common for women to feel a few symptoms, such as mild bloating or breast soreness, before a period. But women with PMS have a wave of emotional and physical symptoms that start in the second half of the menstrual cycle and end after a period begins.

PMS includes many physical and emotional symptoms, such as:

• acne
• bloating
• backaches
• sore breasts
• headaches
• constipation
• diarrhea
• food cravings
• depression or feeling sad
• irritability
• anxiety

PMS is usually at its worst during the 4 days before a period. It tends to disappear 2 to 3 days after the period begins. PMS can happen at any time in women of childbearing age. Not all women get PMS, and some only get the worst symptoms when they are older or closer to menopause.

Although the exact cause of PMS is unknown, it seems to happen because of changing hormone levels in the body and changing chemical levels in the brain. During the second half of the menstrual cycle, the amount of progesterone in the body increases. Then, about 7 days before the period starts, levels of both progesterone and estrogen start to drop.

Some girls’ bodies seem to be more sensitive to these hormone changes than others. Talk to your daughter’s doctor if her symptoms are severe or interfere with her normal activities.

Cramps

Many girls have abdominal cramps during the first few days of their periods. They’re caused by prostaglandin, a chemical in the body that makes the smooth muscle in the uterus contract. These involuntary contractions can range from dull to sharp and intense.

The good news is that cramps usually only last a few days. Using heating pads can help soothe the pain. Over-the-counter ibuprofen, given for 2 to 3 days as soon as a period begins, also can help. Call your daughter’s doctor if she has severe cramps that keep her home from school or from doing stuff with her friends. Also let the doctor know if the cramps do not improve with home treatment.

Irregular Periods

A girl’s body usually does not develop a regular cycle until 2 to 3 years after she begins her periods. During that time, the body is adjusting to the influx of hormones unleashed by puberty. And what’s “regular” varies from girl to girl. The typical cycle of an adult female is 28 days, although some are as short as 24 days and others are as long as 38.

Changing hormone levels might affect the length of a period. A girl’s period may last just a few days during one month and up to a week the next. She may skip months, get two periods very close together, or alternate between heavy and light bleeding from one month to another.

If your daughter’s period still hasn’t settled into a fairly predictable pattern after 3 years, or if it becomes irregular after she’s had several normal periods, make an appointment with her doctor to check for possible problems.

Also, let your daughter’s doctor know if her cycle is less than 24 days or more than 38 days, or if she goes for 3 months without a period.

Delayed Menarche

Girls go through puberty at different rates. Some reach menarche (the medical term for the first period or the beginning of menstruation) as early as 9 or 10 years old. Others don’t have their first periods until they’re well into their teen years. So if your daughter is a “late bloomer,” it doesn’t necessarily mean there’s something wrong.

Genetics plays a big role in determining when girls get their periods. Girls often start menstruating at about the same age at which their mothers or grandmothers did. Also, certain ethnic groups, on average, go through puberty earlier than others. For instance, African-American girls generally start puberty and get their periods before Caucasian girls do.

Let your daughter’s doctor know if she hasn’t gotten her period by age 15, or by 3 years after starting puberty, which begins with breast development.

Problems That May Be Cause for Concern

Although most period problems are harmless, a few conditions can be more serious and require medical attention. These include:

Amenorrhea (the Absence of Periods)

Girls who haven’t started their periods by the time they’re 15 years old or 3 years after they’ve shown the first signs of puberty have primary amenorrhea. This is usually caused by a genetic problem, a hormone imbalance, or a problem with the way the reproductive organs developed.

Hormone imbalances also can lead to secondary amenorrhea, which is when a girl who had normal periods suddenly stops menstruating for more than 6 months or three of her usual cycles.

Since pregnancy is the most common cause of secondary amenorrhea, a girl with skipped periods should have a pregnancy test. In addition to hormone imbalances and pregnancy, other things that can cause both primary and secondary amenorrhea include:

• stress
• significant weight loss or gain
• anorexia (amenorrhea can be a sign that a girl is losing too much weight and may have anorexia)
• stopping birth control pills
• thyroid conditions
• other conditions that can affect hormone levels

Exercising too much (often in sports like distance running, ballet, figure skating, or gymnastics) combined with a poor diet also can lead to amenorrhea. This happens because a girl may lose too much weight or not gain weight during key periods of growth.

But this doesn’t include the usual gym class or school sports team, even those that practice often. To exercise so much that she delays her period, a girl would have to train vigorously for several hours a day, most days of the week, and not get enough calories, vitamins, and minerals.

Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is when periods are very heavy, last much longer than normal, or don’t come regularly. The name might sound serious, but most AUB isn’t a problem and doesn’t need treatment.

Most cases of AUB are due to an imbalance between the levels of estrogen and progesterone in the body, which allows the endometrium (the lining of the uterus) to keep building up. This may lead to the period coming early or late. And when the period does come, the shedding of this thick endometrium can result in very heavy bleeding.

A girl with heavy periods could soak through a sanitary pad or tampon every 1-3 hours. Or, she may have periods that last longer than 7 days. This heavy or prolonged bleeding may keep a girl home from school or social functions because she’s worried she won’t be able to control the bleeding in public.

Because many adolescents have slight hormone imbalances during puberty, lots of teen girls have heavy periods. But in some cases, heavy menstrual bleeding can be caused by problems such as:

• fibroids (benign growths) or polyps in the uterus
• thyroid conditions
• clotting disorders
• swelling, irritation, or infection in the vagina or cervix

If your daughter has heavy periods or periods that last longer than 7 days, talk to her doctor.

Dysmenorrhea (Painful Periods)

There are two types of dysmenorrhea, which is painful menstruation that can interfere with a girl’s ability to attend school, study, or sleep:

1. Primary dysmenorrhea is very common in teens and is not caused by a disease or other condition. Instead, the culprit is prostaglandin, the chemical behind cramps. Some prostaglandin can lead to mild cramps. But large amounts of prostaglandin can lead to nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. Fortunately, these symptoms usually only last for a day or two.
2. Secondary dysmenorrhea is pain caused by some physical condition like polyps or fibroids in the uterus, endometriosis, pelvic inflammatory disease (PID), or adenomyosis (when tissue that usually lines the uterus grows into the muscular wall of the uterus).

Having cramps for a day or two each month is common, but if your daughter has symptoms severe enough to keep her from her normal activities or cramps that last for more than 3 days, discuss it with her doctor.

Endometriosis

In this condition, tissue normally found only in the uterus starts to grow outside the uterus — in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, dysmenorrhea, general pelvic pain, and lower back pain.

Treatment

To determine whether a problem requires treatment, the doctor will ask several questions and do a physical exam. The doctor may do a pelvic exam, blood tests, or urine tests. If there might be a structural problem, an ultrasound or CT scan might be done. These tests can help the doctor decide how to handle a condition.

Growths such as polyps or fibroids often can be removed, and endometriosis treated with medicines or surgery. If a hormone imbalance is to blame, the doctor may suggest hormone therapy with birth control pills or other hormone-containing medicines. Conditions like clotting disorders or thyroid problems also may require treatment.

For menstrual pain not due to any medical problem, anti-inflammatory medicines like ibuprofen are the most effective treatment.

When to Call the Doctor

Although most period problems aren’t cause for alarm, certain symptoms do call for a doctor visit. This is particularly true if a girl’s normal cycle changes.

So take your daughter to her doctor if she:

• Hasn’t started her period by the time she’s 15 or her period hasn’t become regular after 3 years of menstruating. The most likely cause is a hormone imbalance (which may need treatment), but this also might point to another medical problem.
• Stops getting her period or it becomes irregular after it has been regular. Also let your daughter’s doctor know if her cycle is less than 24 days or more than 38 days, or if she doesn’t get a period for 3 months at any time after first beginning to menstruate.
• Has heavy or long periods, especially if she gets her period frequently. In some cases, significant blood loss can cause iron-deficiency anemia. Also, heavy bleeding could be a sign of a growth in the uterus, a thyroid condition, an infection, or a blood clotting problem.
• Has very painful periods. Having cramps for a couple of days is normal, but if your daughter isn’t able to participate in her normal activities, or has cramps for more than 3 days, let the doctor know. She might have a medical problem, such as endometriosis, causing the pain.

Helping Your Daughter Feel Better

When your daughter’s having a particularly bad bout of PMS or cramps, you can help make her more comfortable. Suggest that she:

• eat a balanced diet with lots of fresh fruit and vegetables
• reduce her salt intake (salt can cause water retention) and caffeine (which can make her jumpy and anxious)
• include foods with calcium, which may reduce the severity of her PMS symptoms
• try over-the-counter pain relievers like acetaminophen or ibuprofen for cramps, headaches, or back pain
• take a brisk walk or bike ride to relieve stress and aches
• soak in a warm bath or put a hot water bottle on her abdomen, which may help her relax

If you notice that your daughter’s periods are causing her great discomfort or interfering with her life, talk to her doctor to make sure nothing else is causing the problem and to see if anything can help. Sometimes hormone treatment, often in the form of birth control pills, can help ease many symptoms of uncomfortable periods.

Most important, talk to her and explain that most annoying or uncomfortable parts of menstruation are normal and may improve over time. And be understanding when she’s cranky and unhappy. After all, no one’s at her best all the time.