A parent’s ultimate guide to periods

For adolescents and teens, the developmental stage of puberty can be full of changes — socially, emotionally and physically. One significant milestone is when your child is expecting their first period. Some kids might be excited about this rite of passage, and some may be overwhelmed.

As parents trying to take their kids’ changes in stride, we understand that this time may be overwhelming for you, too.

Here, Dr. Jan Johnson, a pediatrician in CHOC’s primary care network, gives you an ultimate guide to periods.

What is a period?

Menstruation (a period) typically happens monthly  and is the process by which the uterus sheds its lining. This is in response to changes in the hormones throughout the body.

Hormones (chemical messengers) from the pituitary gland in the brain communicate to the ovaries and the body. This causes the ovaries to release the hormones estrogen and progesterone into the body. Estrogen and progesterone cause the ovaries to mature and release an egg through a process called ovulation. Estrogen and progesterone also cause the lining of the uterus to build up in preparation for a possible pregnancy.

Once the egg is released from the ovary, it travels down the fallopian tube toward the uterus. If the egg meets a sperm as it travels, it can attach to the lining of the uterus  and may develop into a fetus/pregnancy. If the egg does not meet a sperm, it will travel into the uterus and with more changes in hormone levels, eventually be shed with the lining of the uterus as a period.

This process happens repeatedly and usually takes about a month for the lining to build up again and break down.

When do most kids get their first period?

Every teen’s body has its own schedule, and periods can start at different ages. Most kids get their first period when they are between 10 and 15 years old. The average age is 12. However, there is not one right age to get a period.

There are some physical changes that can symbolize a period starting soon. Usually, a preteen or teen will get their period about two years after their breasts and pubic hair begin to develop. Another sign to look for is vaginal discharge fluid (like mucus) that typically begins six months to a year before the first period.

How long do periods usually last? How much blood is there?

Periods usually last about five to seven days, but for some, they can be longer or shorter. Period flow levels vary and can range from light to moderate or heavy. On average, a child will only lose a few tablespoons of blood during a period.

If a period lasts more than seven days, needs more than five pads per day, or has heavy bleeding or cramping, talk to your pediatrician about what is causing this.

How often do periods happen?

For the first couple of years after menstruation begins, cycles are often irregular. They can happen every three weeks, six weeks or only a few times a year.

About two to three years after the first period, it should come around once a month (usually between every 21 to 45 days).

If your teen’s periods are still irregular after a couple of years, a CHOC expert has advice

What are the symptoms of a period?

Period symptoms can differ for every teen, as can the strength of each symptom. Some may not have any symptoms other than bleeding, while others may have many.

Some symptoms include:

• Mood swings
• Irritability
• Tension
• Bloating
• Breast tenderness
• Muscle aches
• Headaches
• Acne
• Abdominal cramps
• Lower back pain

Menstrual cramps are a common symptom of periods. Usually, teens do not get severe cramps for the first year or two of their periods. After the first couple of years of having periods, most teens will experience cramping — but some never do.

Cramps can range in pain and length of time, but they typically last a few days. You can help relieve the discomfort by using over-the-counter pain medicine, such as ibuprofen, a hot bath, a heating pad or through exercise.

What Is PMS?

PMS (premenstrual syndrome) is when someone has emotional and physical symptoms that occur before or during their period. This can include mood swings, sadness, breast tenderness, bloating and acne.

These symptoms usually go away in the first few days of a period. Teens typically do not develop PMS symptoms until years after the menstruation cycle starts; some never do. For those who do experience PMS, rest, exercise and a balanced diet can help with the symptoms.

What to expect from polycystic ovarian syndrome (PCOS), which can be common in teens

Should my child use pads, tampons or menstrual cups?

When deciding what menstrual hygiene products to use, it’s important that your child feels physically and emotionally comfortable. Many teens start with using pads and transition to tampons or menstrual cups when they are older; however, they do not have to wait to use tampons or menstrual cups. Tampon insertion and removal can require some maturity, regularity and monitoring to be safe. 

Pads

Pads — sometimes called sanitary pads or sanitary napkins — are rectangles of absorbent material that stick inside your child’s underwear. Some pads also have extra material like “wings” that can hold over the sides of the underwear to hold the pad in place.

Pads come in different sizes for heavier and lighter periods. For a heavy period, pads may need to be changed out three to four times per day.

Tampons

When a child first starts their period, tampons might feel uncomfortable or unusual while the pelvis and vagina are growing.

If your child decides to use tampons, each box comes with instructions, and it can be helpful to read them together. At first, your child may become irritated with trying to insert tampons but explain that it gets easier with practice.

Start with a slim tampon applicator that’s easier to insert for the first time. It also helps to try inserting a tampon on the heavier flow day during the period, so it slips in easier.

Tampons should be changed out every four to six hours to prevent spotting and leaks and reduce the risk of infection.

For both pads and tampons, make sure that your child knows how to properly dispose of them in the trashcan by wrapping them in a piece of toilet paper. You can show them the small trashcans located in public restrooms. Make sure they know to avoid flushing pads or tampons down the toilet to prevent toilet clogging issues.  

Menstrual cups 

Menstrual cups can be awkward at first, but like tampons, they get easier to insert with practice. Your child may be uncomfortable with the process of using a menstrual cup, but once put in correctly, they are able to do everyday activities without any issues with the cup. Many brands of menstrual cups come with instructions in the box or can be found on the website. Going through the directions can help ease your child into using it.

When should I call the doctor about my child’s period?

Most teens do not have any problems with their periods but call your doctor if your child:

• Is 15 years and has not started their period.
• Started developing breasts more than three years ago and does not have a period.
• Is more than two years after their first period and their periods still do not come every three to six weeks (especially if they miss three or more periods in a row).
• Has severe cramps not relieved by ibuprofen (Advil or Motrin).
• Has very heavy bleeding (bleeding that goes through a pad or tampon faster than every two hours).
• Has severe PMS that gets in the way of their everyday activities, including school.

How to talk to your kids about periods

When should I talk to my kids about periods?

Talking to your kids about periods shouldn’t be a one-time conversation at a specific age. It should be spread out in multiple conversations to slowly build on your child’s understanding. Over the years, you can provide more information as your child is ready.

Most children can understand the basics of periods by the time they are six or seven years old. If your child is not asking questions about periods, try to bring it up in natural moments, such as:

• When a child asks about puberty or changing bodies.
• If your child asks where babies come from.
• If you are buying pads or tampons.

For example, if your younger child sees a tampon and asks what it’s for, you can explain it in basic terms they will understand. You can say, “Most women have a period every month, meaning they bleed from their vagina a little. It’s how the body gets ready for a baby one day, and the tampon catches the blood, so it doesn’t go into the underwear.”

Kids should know what’s going to happen to their bodies before reaching puberty. If you are unsure if your child knows about periods, ask them. You can see what information they do know and how to proceed further with additional information. Answer any questions simply and directly.

Having this conversation with your elementary age child can make it more comfortable and natural for them to talk about as they get older. You are a trustworthy source of information. 

What should I talk about?

Deciding what to talk about depends on your child’s age and level of development. Discover what they already know and address any misinformation or questions that they have.

Sharing your own experiences can help break the ice, and make your child feel more comfortable asking questions. If they are having sex education lessons in school, try to talk about what they are learning and if they have any questions about what they have seen so far.

While discussing the process of menstruation, explain what a period is, how long periods last, period symptoms, signs of PMS and choosing between pads and tampons. When discussing these topics, it might be helpful to have a diagram to refer to. There are several books on the market which can help in your discussion.

What if I have trouble talking to my kid/s about periods?

If you feel uncomfortable talking with your kids about periods, there are many ways to help ease the awkwardness. Here are some tips:

• Use books and/or videos to lay an educational base and open the conversation.
• Prepare your child for a doctor checkup by letting them know the doctor may have questions about periods.
• Reach out to a school counselor for advice.
• Ask your child’s teacher if there are any plans for sex education.
• While shopping for menstruation products, ask your child if they have questions about it.
• Talk with your family doctor about communication resources for menstruation and puberty.
• Reach out to a trusted family member to discuss periods with your child.

Your teen’s or preteen’s common period questions: Answered

Having the talk about periods can be uncomfortable for both you and your child; however, the important thing is that your child has reliable information. Creating an open and safe environment where they can ask their questions is vital. The more that they understand about their bodies, the better they can make healthy choices.

CHOC experts are here for you as you try to answer your child’s hard questions about their period. Use the following Q&A to help ease the awkwardness:

Can a tampon get lost inside you?

No. The tampon is held in place by the walls of your vagina, and the tip of it will end at your cervix. There’s nowhere for it to go.

If you are having trouble removing your tampon, wash your hands, lie down and take a deep breath to relax. Then reach inside your vagina with a clean finger and feel for the string. When you feel it, take two fingers and pull the string out.

Am I still a virgin if I use a tampon?

Yes. It’s a common misconception that a tampon can “pop your cherry” or cause the hymen to tear. Although this happens occasionally, it’s not likely. Either way, tampons will not cause you to lose your virginity. Only having sex can do that. 

Can I become pregnant if I haven’t had my period yet? Or if I have irregular periods?

Yes. You can get pregnant when your period starts, and even before your first period. This is because your hormones can be active and can lead to ovulation. Because you can ovulate before having your first period, it’s possible to become pregnant if you have sex.

Can birth control help with cramps?

Many teens will get cramps at the beginning of their periods. Sometimes, medicine like ibuprofen, regular exercise and a warm bath or compress can help. However, if more conservative measures do not work, birth control can help with cramps by controlling irregular hormone cycles.

Birth control can decrease the number of prostaglandins, or chemicals that your body produces to make the muscles of the uterus contract. With few contractions, you will feel less pain from your cramps. Birth control can also regulate irregular periods, decrease the amount of blood flow during your period and manage PMS symptoms.

Will I get my period during my whole life?

You will stop having your period usually between the ages of 45 and 51 when you go into menopause. Once that happens, it means that you will also not have the ability to become pregnant anymore.

Do I have to stop playing sports or swimming while I have my period?

You can do everything you normally would do while on your period if you are comfortable. You can choose to wear a tampon when you swim while on your period. Many teens and athletes use prescription hormone pills to skip their periods.

If you are looking for a new doctor for your child for this new phase of life, visit our Wellness and Primary Care page to find a pediatrician near you.

For more health and wellness resources from the pediatric experts at CHOC, sign up for the Kids Health newsletter.

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