Women’s Health Week: ‘Mom, is my period normal?’

By: Gina Sucato, M.D., M.P.H., Associate Professor of Pediatrics, Division of Adolescent Medicine, Children's Hospital of Pittsburgh of UPMC

National Women’s Health Week runs May 12 to 18 with the goal of empowering women to make their health a priority. This is the first in a series this week focusing on women’s health issues from the teenage years through menopause.

A girl’s first period is considered an important milestone and an indicator she’s “growing up.” After sharing the news, many girls prefer to manage their periods on their own without much discussion with family. But because their period is brand-new, girls don’t yet know what’s “normal.” As a result, every now and then, a girl’s periods can be abnormally irregular, heavy, or long for an extended amount of time before she gets needed help for this.
It’s a good idea for parents to encourage girls to keep track of their periods on a calendar and to review it with them periodically for the first couple of years. There are several free smart phone apps that make this easy. As a rule, girls’ cycles are longer than adult women’s. However, anywhere between 21 and 45 days from the first day of one period to the first day of the next is considered OK. Girls with more than two cycles outside this range or who skip their period for three consecutive months may be fine, or they may need further evaluation. A visit to the primary care physician can offer reassurance or initiate further management if needed.

Knowing how much bleeding is too much bleeding can be a big challenge to someone who’s never had a normal period. A normal period does not last longer than seven days. Other signs that bleeding may be too heavy include needing to use more than six (soaked) pads or tampons per day, passing clots larger than the size of a quarter, or leaking onto clothes during the day or onto bed sheets at night. However, leaking can also be a sign of not changing sanitary products often enough. This is important to discuss with girls, especially those who get their period while still in elementary school. For girls in middle and high school, bathroom access is sometimes excessively restricted during the day; accommodations can be made for girls during their period by talking with school officials.

Menstrual cramps typically do not appear until after a girl has already had her period for a couple of years. For girls whose cramps require more than a good night’s rest, a healthy diet, and a heating pad, non-steroidal anti-inflammatory medicines such as ibuprofen (found in brands such as Advil and Motrin) and naproxen sodium (as in Aleve) work well. Starting the medicine as early as possible, before cramps are severe, and using it every eight hours for the first day is most helpful. For girls whose cramps do not respond to this, seeking medical care for further treatment makes good sense. Girls should not need to miss school or skip activities because of their periods!

Primary care doctors can address most questions related to girls’ periods. However, when additional concerns exist, the Division of Adolescent Medicine at Children’s Hospital of Pittsburgh of UPMC is staffed with doctors and nurse practitioners who are experts in the care of adolescents.