Menstrual health is not just about menstruation and menstrual issues. It’s a much broader topic than that. Menstrual health is an important part of pubertal growth or adolescence growth. Pubertal health awareness and education should start at the time of puberty and not when the girl starts her first period. It should be a part of education for both boys and girls. Boys and girls should be aware of pubertal changes, what and why they experience these changes and ways to deal with it.
Why should awareness be about pubertal health instead of only menstrual health?
It’s important that boys and girls must be aware of changes they experience during puberty, so they can sail through this period smoothly without much anxiety especially when the girls hit their menarche.
Adolescence is a period of transition between childhood and adulthood. Most adolescents don’t have any formal or informal education about the changes they experience during this period which leads to anxiety and decreased self esteem in young kids. Sometimes due to wrong information kids may indulge in unhealthy behavior and can harm themselves physically and mentally.
During this period children go through many biological, emotional and social changes. All of these aspects should be kept in mind while dealing with the adolescent age group.
Puberty comes a little early in girls compared to boys. Physical changes mostly begin around the age of 9 to 10 years or even earlier in some cases. The order of development in girls begins with growth spurt-> then there is breast development-> followed by pubic and axillary hair growth-> then final growth spurt and last is the menstruation. All these changes are usually completed between the age of 10 to 16 years.
It’s important to educate girls about personal hygiene and menstrual hygiene. They should have access to hygienic menstrual products and clean, hygienic washrooms at home and at school as well.
How to talk to kids about menstruation?
- Explain to them that it is a normal, natural, physiological developmental change.
- It’s important for continuing our progeny.
- It’s a part of pubertal developmental changes which are different in boys and girls.
- Periods are a combination of anatomical, biological, and physiological changes and nothing to be ashamed about.
- They should also be explained about other associated changes like increased vaginal discharge, tingling, pain and growth in breasts, sexual desires.
- Importance of a healthy diet and exercise should be emphasized upon.
- Sexual interests also increase during puberty, so a talk about that also will be a good idea.
How to deal with first period in girls?
- Completely informed girls are more confident when they hit their first period than the girls who are not much aware about menstruation.
- They should be provided with hygienic menstrual products and should be encouraged to continue their normal routine.
- It would be a good idea if they carry an extra pair of panties and pants while going out, in case there’s a leak.
- Ginger tea, turmeric milk or heating pads have proven efficacy in dealing with period pain or dysmenorrhea.
- 60-70% of the blood loss occurs in the first one to two days, so the girl can rest for these days, if she is not comfortable to move out.
- Over the counter painkillers can be helpful to relieve pain but a doctor must be consulted in case pain is so severe that it hampers their routine or is continued for all 5-7 days.
Menstrual abnormalities associated with puberty:
Painful periods/ Dysmenorrhea:
Periods in initial years can be more painful. Dysmenorrhea is chronic, cyclic pain in the lower abdomen, pelvis or back which is associated with period cycles. It’s the most common menstrual associated complaint and its prevalence is around 45-90% in the reproductive age group. Certain factors increase the risk of pain like menarche, not much awareness about periods leading to anxiety, depression, family history, smoking, nulliparous(who have not given birth).
Pain can also be due to any underlying pathology in pelvic organs like endometriosis, fibroid, adenomyosis or pelvic inflammatory disease.
Generally the pain starts 2-3 years after the start of periods or menarche. The pain begins 2-3 days prior to the start of menstruation and lasts for 24-48 hours after the period starts. It’s in the lower abdomen, may also be present in the back, sometimes vagina, and may be associated with nausea, vomiting, giddiness.
If the pain is not relieved by home remedies or it lasts for more than 3 days from starting of periods, or is severe enough to affect daily routine then a thorough examination by a doctor is advisable.
Home remedies include warm turmeric milk, ginger tea, heating pad, mild exercises which elevate the hormones including yoga. Child pose, butterfly pose, shav aasan, angel pose, lateral twists are helpful yoga poses to relieve pain.
Heavy bleeding/ Menorrhagia:
Menstrual abnormalities are common in adolescent age groups. Periods are generally heavy and irregular. Most times these girls develop a normal cycle in later years and are fertile.
Heavy periods are said when bleeding lasts for more than 7 days or period comes before 21 days, or when the blood loss is severe enough to cause anemia. Its generally more than 80ml per cycle or more than 4-6 pads or tampons soaked per day approximately to be labelled as menorrhagia.
Generally the cause of these irregular cycles is dysfunctional uterine bleeding due to anovulatory cycles leading to unopposed estrogen causing endometrial hyperplasia leading to heavy bleeding. 90 to 95% of times dysfunctional uterine bleeding can be treated by reassurance, rest and medication for 3-6 period cycles.
Precocious puberty:
Precocious puberty is defined as the condition where a girl develops secondary sexual characters before the age of 8 years or starts menses before 10 years. These cases should be evaluated by the doctor for any underlying pathology and the management. Periods can be postponed by certain medicines in case needed.
Delayed puberty:
Delayed puberty is generally diagnosed when the breast tissue or pubic hair have not developed by the age of 13 to 14 years or menarche has not been attained till 16 years of age.
This delay in puberty may be due to causes like chronic illness, malnutrition, imperforate hymen, transverse vaginal septum, or certain genetic/ endocrine factors. All of these need to be evaluated by the doctor.
Menstrual hygiene products:
There are many menstrual hygiene products available in the market. You need to talk to your girl about each and every option, their pros and cons and help her decide one to use.
1. Cloth pads- These are being used since ages in our society by females. An old, washed cloth is used by folding in layers.
Pros- It’s economical, easily available, acceptable by generations.
Cons- If not properly washed it can cause infection, rashes. Not eco-friendly.
2. Disposable pads- These have been promoted most and they are the most popular menstrual product available.
Pros- Hygienic, easy available, easy to use and generally non messy.
Cons- Includes many chemicals, bleach, dioxins which are not good for our health and may even cause cancer.
3. Tampons- Tampons are easy to use, placed in vagina and absorbs blood like pads.
Pros- As it goes inside vagina and nothing is visible outside, girls can wear their favorite clothes, go swimming, and dance without much difficulty.
Cons- A bit discomfortable when it expands on absorbing blood. If forgotten inside for long, it may cause infection including a life threatening condition called toxic shock syndrome, though it is rare.
4. Menstrual cups- They are made of medical grade silicone and are funnel shaped. They are placed inside the vagina, where they collect blood and it has to be emptied after a certain time.
Pros- Environment friendly, economical, as it only collects blood and not absorbs any, chances of infection are rare. One cup may last around 6-8 years.
Cons- Proper technique of insertion may be a bit difficult. Some people find emptying the cup a bit of a messy affair.
Click on this link to read my blog on menstrual cups, https://docdaisyclinic.com/how-and-why-to-use-menstrual-cups/
5. Reusable pads/ panties- These can be used instead of disposable pads to lessen the burden of disposable menstrual products. They are made of microfiber layers which absorb blood.
Pros- Economical and eco friendly compared to disposable pads. One pad/panty can be used for many cycles, after washing.
Cons- Washing and sun drying, which is essential to clean it properly, are cumbersome for some.
There are many other menstrual related issues like premenstrual syndrome, less periods or hypomenorrhea or long cycles of more than 45 days like oligomenorrhea. Sometimes cycles can come at a shorter interval of less than 21 days called polymenorrhea. Conditions like endometriosis, vicarious menstruation( presence of endometrium in other body parts apart from uterus causing cyclical bleeding like bleeding from nose, eyes, ovaries), can also be present in some females in later years. All these conditions need evaluation and management by a doctor.
So menstrual talk should be a part of pubertal changes for both boys and girls. Talk about your experiences, physiology behind it, why it is important and how to take care of themselves during periods and personal hygiene in general. With support of family members and proper knowledge, girls can embark on these pubertal changes more confidently and grow beautifully.
How to talk with kids about menstrual health?
