Recent News and Articles on the Keywords: menstrual problems + menstrual problems: + menstrual  Related to the article below (Last Update: 8/7/2008)

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Menstrual Problems

Everyone knows the teen years can be difficult - for both teens and parents. All those physical changes during puberty can make adolescents feel awkward and unsure of themselves.

This is particularly 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 can also be confusing, particularly if she encounters certain problems like irregular periods or premenstrual syndrome (PMS).

What Are Some Common Menstrual Problems?
Most issues teens confront when they start menstruating are completely normal. In fact, many girls and women have had to deal with one or more of them at one time or another:

Premenstrual Syndrome (PMS)
PMS includes both physical and emotional symptoms that many girls and women get right before their periods, such as:

• acne
• bloating
• fatigue
• backaches
• sore breasts
• headaches
• constipation
• diarrhea
• food cravings
• depression or feeling blue
• irritability
• difficulty concentrating
• difficulty handlingstress

Different girls may have some or all of these symptoms in varying combinations. PMS is usually at its worst during the 7 days before the period starts and disappears once it begins. But girls usually don't develop symptoms associated with PMS until several years after menstruation starts - if ever.

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

Cramps
Many girls experience 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 be either dull or sharp and intense.

The good news is that cramps usually become less severe as girls get older and they don't usually last long. But call your daughter's doctor if she has severe cramps that keep her home from school or from doing stuff with her friends.

Irregular Periods
It can take up to 2 years from a girl's first period for her body to develop a regular cycle. During that time, the body is essentially adjusting to the influx of hormones unleashed by puberty. And what's "regular" varies from person to person. The typical cycle of an adult female is 28 days, although some are as short as 22 days and others are as long as 45. Changing hormone levels might make a girl's period short 1 month (just a few days) and long the next (up to a week). She can skip months, get two periods almost right after each other, or alternate between heavy and light bleeding from 1 month to another.

But any girl who's sexually active and skips a period should see a doctor to make sure she's not pregnant. And if your daughter's period still hasn't settled into a relatively predictable pattern after 3 years, or if she has four or five regular periods and then skips her period for a couple of months, make an appointment with her doctor to check for possible problems.

Delayed Menarche
All 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 and 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 with her.

When girls get their periods actually depends a lot on genetics. Girls often start menstruating at approximately the same age their mothers or grandmothers did. Also, certain ethnic groups, on average, go through puberty earlier than others. For instance, African-American girls, on average, start puberty and get their periods before Caucasian girls do.

If your daughter hasn't started her period by the time she's 16 or you're concerned, see the section, "When Should You Call Your Child's Doctor?"

What Are Some Menstrual Problems That May Be Cause for Concern?
Although most period problems are harmless, a few conditions can be more serious and require medical attention.

Amenorrhea (the Absence of Periods)
Girls who haven't started their periods by the time they're 16 years old or 3 years after they've shown the first signs of puberty have primary amenorrhea, which is usually caused by a hormone imbalance or developmental problem. Hormones are also often responsible for secondary amenorrhea, which is when a girl who had normal periods suddenly stops menstruating for more than 6 months.

Of course, pregnancy is the first possible cause to rule out when a girl skips periods. But some other things that can cause both primary and secondary amenorrhea include:

• low levels of gonadotropin-releasing hormone (GnRH), which controls ovulation and the menstrual cycle
• stress
• significant weight loss or gain
• anorexia (In fact, amenorrhea can be an initial sign that a teen is losing too much weight and may have anorexia.)
• stopping birth control pills
• thyroid conditions
• ovarian cysts
• other conditions that can affect hormone levels

Something that can also cause primary and secondary amenorrhea is excessive exercising (usually distance running, ballet, or gymnastics) combined with a poor diet, which usually results in inappropriate weight loss or failure to gain weight during 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.

Menorrhagia (Extremely Heavy, Prolonged Periods)

It's normal for a girl's period to be heavier on some days than others. But menorrhagia usually leads to soaking through at least one sanitary napkin (pad) an hour for several hours in a row or periods that last longer than 7 days. Girls with menorrhagia sometimes stay home from school or social functions because they're worried they won't be able to control the bleeding in public.

The most frequent cause of menorrhagia is 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. When the endometrium is finally shed during menstruation, the resulting bleeding is particularly heavy.

Because many adolescents have slight hormone imbalances during puberty, menorrhagia isn't uncommon in teens. In some cases, heavy menstrual bleeding is caused by:

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

Dysmenorrhea (Painful Periods)

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

• Primary dysmenorrhea is more common in teens and is not caused by a disease or other condition. Instead, the culprit is prostaglandin, the same chemical behind cramps. Large amounts of prostaglandin can lead to nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. Fortunately, these symptoms usually last for only a day or 2.
• Secondary dysmenorrhea is pain caused by some physical condition like polyps or fibroids in the uterus, endometriosis, pelvic inflammatory disease (PID), or adenomyosis (uterine tissue growing into the muscular wall of the uterus).

Having cramps for a day or 2 each month is common, but signs of dysmenorrhea should be discussed with your child's 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, and general pelvic pain.

Treating Menstrual Problems

To determine whether a problem requires treatment, your child's doctor or gynecologist will likely do a thorough pelvic exam, a Pap smear, blood tests (to check hormone levels), and sometimes even urine and stool tests. If he or she thinks there's some sort of growth in the uterus or fallopian tubes, an ultrasound or CAT scan may be performed. Together, those tests can reveal how a condition should be handled.

Growths such as polyps or fibroids can often be removed and endometriosis can often be treated with medications or surgery. If a hormone imbalance is to blame, the doctor will likely suggest hormone therapy with birth control pills or other estrogen and/or progesterone-containing medications.

And for severe menstrual pain with no underlying medical cause, anti-inflammatory medicines are the most effective treatment. Conditions like clotting disorders or thyroid problems may require treatment with medications as well.

When to Call Your Child's Doctor

Although most period problems aren't cause for alarm, certain symptoms do call for a trip to the doctor. 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 16 or her period hasn't become regular after 3 years of menstruating. Although the most likely cause is a hormone imbalance (which may need treatment), this might also point to a problem with her diet, possibly even an eating disorder. If she doesn't consume enough vitamins, minerals, and calories, it could harm her growth and development.
• stops getting her period or it becomes irregular after it has been regular for about 6 months or longer. Again, this might signal a problem with nutrition, maybe even anorexia, which can be dangerous if left untreated. Sometimes girls who are developing anorexia will stop having periods months before significant weight loss has occurred.
• has extremely heavy or long periods, especially if her cycle is short and 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. She might have endometriosis or benign (noncancerous) growths that should be removed. Or, if she's sexually active, she could have pelvic inflammatory disease.

What You Can Do to Help Your Daughter
When your daughter's experiencing a particularly bad bout of PMS or cramps, there are several things you can do at home to make her more comfortable. Suggest that she:

• eat a balanced diet with lots of fresh fruit and vegetables.
• reduce her intake of salt (which can cause water retention) and caffeine (which can make her jumpy and anxious).
• take magnesium, B-complex vitamins, and 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 (because exercise releases endorphins - chemicals in the body that make you feel good).
• 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 usual periods are causing her great discomfort and interfering with her life, check with her doctor about hormone treatment, usually in the form of birth control pills, which can help ease many symptoms associated with uncomfortable periods.

But the most important way you can help your daughter feel more at ease about her period is to talk to her and explain that most annoying or uncomfortable conditions that accompany 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 - including you.