Blossoming into womanhood

Salt Lake mother Michelle Kubota suggests parents create a “starter kit” to prepare daughters for their first period, including items such as sanitary pads, chocolates, ibuprofen, a tea bag and fun stickers. Gregory Yamamoto • The Honolulu Advertiser

Whether or not parents are ready for it, their daughters inevitably grow out of their pigtails and Barbie dolls and begin to take interest in makeup and boys.

For many parents, talking to their daughters about the physical and psychological changes that take place when they begin to blossom into womanhood can be an uncomfortable and even difficult task. Especially when talking about menstruation, seemingly among the last taboo topics in American society.

But parents should be prepared to talk to their daughters about periods sooner than they think.

Recent studies show that many girls begin menstruating at an earlier age than in years past.

"It used to be the average age was 12 or 13, and the average is 10 now," said Dr. Cris Ancog, a pediatrician at Kaiser Permanente.

Dr. Simon Chang, an ob/gyn at Straub Clinic & Hospital, has also noticed this change.

"Over the years, for some reason, menstruation is starting earlier and earlier (among girls)," Chang said.

He said that while he couldn’t cite any solid studies explaining the reason for this trend, there are various theories for it.

Ancog said that a child’s weight may have something to do with having earlier menstrual periods.

"We think it’s related to childhood obesity and that the more fat (a girl has) triggers off puberty earlier," she said.

Turning into a woman

While menstruation is a significant event in a girl’s life, both Ancog and Chang said that girls actually begin to approach womanhood before that.

A "girl begins to blossom a couple years before menstruation with breast development," Chang said. He said that the average age for breast development is between the ages of 8 and 10.

Parents can expect their daughters to get their first periods about one or two years after breast development. Other signs include pubic hair growth and emotional changes, such as moodiness.

When girls begin to show such signs, parents should be prepared to talk to their daughters about menstruation.

"It’s always good for the parents to talk to their children before menstruation starts," Chang said. "That way . . . (their daughters) will know what to expect."

Michelle Kubota of Salt Lake, 44, said that she talked to her two daughters about menstruation when they started showing signs of breast development.

Kubota’s eldest daughter, now 22 years old, was 13 when she got her first period, and her youngest, now 20, was about 10 or 11.

Like Chang, Kubota thinks it is important for parents to prepare their daughters for menstruation.

"The sight of blood is quite scary and usually associated with pain," Kubota said. "It’s important to explain that all girls go through this and it is normal."

Kubota said that by the time she talked to her older daughter about periods, the girl already knew about it because of a health class she had in the seventh grade.

Kubota added that since her two daughters are so close in age, when she talked to her youngest daughter about menstruation, the younger child was already familiar with it and knew what to expect because she had been exposed to what her sister went through.

Annette Brown of Mililani, 39, has two daughters, ages 13 and 10. Her 13-year-old got her first period last year at age 12.

Brown said she knew that her daughter was going to get her period soon because of the physical changes she was going through. So she gave her daughter a book that explained what menstruation is.

"That gave her an opportunity to look at it by herself and become comfortable (with the subject)," Brown said.

After that, Brown said, she talked to her daughter "when we had a moment by ourselves (and) we were in her room." Brown then went through the book with her daughter, answering any questions that the girl had.

Ancog also said there isn’t an absolute specific moment that’s right for everyone to have "The Talk."

"I think it’s like this gradual process, and so you should start talking to your kids about sex, puberty and changes when they’re 6 or 7," she said. "Then when it comes time to talk about your periods, it’s just one of those things. . . . It’s usually the parents who feel uncomfortable, not the girls."

‘Part of growing up’

Ancog suggests that parents speak in a straightforward way, using medical terms rather than made-up language. "I don’t use any fancy, foo-foo terms or anything like that," she said with a smile.

Ancog’s explanation for menstruation is simple: Your uterus is preparing to have a baby someday and the blood is where the baby gets its nutrition. If you don’t have a baby in there, the blood comes out. (See accompanying story.)

"That’s pretty simple for them to understand, and most girls get that," she said.

Experts and parents who have had that talk with their daughters offer these tips:

Find an appropriate time to talk to your daughters about menstruation for the first time.

Ancog said that if parents haven’t been having conversations with their daughters about sex and puberty, they should find a "window of opportunity where your child is opening up to you." Children may show that they are ready to talk about it if they begin asking questions that are related to menstruation or puberty. Ancog recommends parents "look for that window" to have the conversation.

Be down-to-earth about it.

Ancog has two daughters, ages 11 and 6, and although neither of them has started their menstrual periods, Ancog said that they are familiar with the subject.

"It just kind of comes up in our house. . . . We talk about how babies are born and stuff like that," Ancog said. "We just kind of take it matter-of-factly."

Ancog said it’s best that parents be up-front about menstruation. That way, girls will not think that having menstrual periods is something weird or something to be ashamed of.

Let them know that it is a natural process.

Ancog said parents shouldn’t scare their daughters and tell them that it is going to be an awful thing.

"You want to reassure them that it’s natural (and) it’s part of growing up," Brown said.

Prepare them for the very first day they get their period.

This is so that they are not surprised when it happens. Parents should prepare their daughters by telling them not to panic when they see blood and informing them as to where they can find the sanitary pads and how to use them.

"I would suggest creating a starter kit and including items that will prepare your daughter for that ‘big day,’" Kubota said.

She recommends parents include in the kit some sanitary pads, a book that provides information about periods and "fun things," such as a chocolate bar, ibuprofen, tea bag and stickers to "make them smile." She said parents can place the items in a box and dress it up so that it looks pretty.

"When you have that talk with your daughter, you can provide her with this starter kit and explain things easily," Kubota said. If your child has a locker at school, you might consider making two kits: one for school and one for home, in case she is surprised by her period when she’s not at home and you can’t be nearby to help.

Tell them what they can expect once they start menstruating.

Ancog said parents should let their daughters know that, once they begin menstruating, they may experience cramping, back pain and irritability.

Girls should also know that irregular cycles are natural after their first periods. They may get their period the first month but not for the next two months, for example; this is normal.

Chang said that if parents want to do so, they can also use this opportunity to talk to their daughters about sex.

"That would be a good time to talk about it because, in actuality, once you start having periods, the potential for pregnancy is there," Chang said.

"If the conversation goes that way, you can," Ancog said. "If it doesn’t, you don’t have to. But you should start talking to your children about sex at an early age."

Keep communication open.

Brown is very open with her daughters and makes sure they know that if they have questions or concerns, she’s there for them.

Although it is more common for mothers to have this talk with their daughters, there are some cases where fathers have to do the job.

Ancog said that the same advice applies to them.

But if the fathers or daughters feel uncomfortable, or if the daughters have questions that their fathers can’t answer, Ancog said that they can talk to a close female family member, such as an auntie, or consult a doctor.

Some basic answers

Dr. LeighAnn Frattarelli, an ob/gyn at Kapi‘olani Medical Center for Women & Children and an assistant professor of obstetrics and gynecology at the University of Hawai‘i-Manoa’s John A. Burns School of Medicine, offers answers to some common questions about menstruation that girls may ask their parents:

Q. When will I start my menses?

A. Girls start their menses at different ages. Menstrual periods may begin as early as age 9 or as late as age 17.

Q. How can I tell when the bleeding will begin?

A. Initially, this may be difficult. You may notice an increase in clear vaginal discharge about six months before your first menstrual period. Some women get cramping a few hours prior to the bleeding. This frequently does not occur prior to the first menstrual period.

Q. Where does the blood come from?

A. The blood comes from the uterus. This is the female organ where women carry their babies prior to the baby being born. Once the uterus is mature, the female hormones, estrogen and progesterone, prepare it for a baby each month. If there is no baby to grow there, the thick lining of the uterus, made of blood, will shed as the female hormones decrease.

Q. Will the bleeding hurt?

A. No, you won’t feel pain from the blood coming out. Some girls do get cramping in their lower abdomen when they are on their menses. This comes from the uterus and may begin prior to the menstrual period. It may last a few hours or a few days. This is normal, but exercise, a heating pad and medications like ibuprofen may help relieve the discomfort.

Q. How do I make the bleeding stop?

A. The bleeding will stop on its own.

Q. How long will I bleed?

A. The length of your first menstrual period can vary. Usually it will last one to seven days, but occasionally it will last longer. Once your female hormones and organs are completely mature, you will probably bleed about the same amount of time every month, for three to seven days.

Q. How often will I bleed?

A. For the first one to four years, your menses may come very irregularly, every few weeks to every few months. During this time, the female hormones and organs are continuing to mature. Once the female organs completely mature and an egg begins to come out from the ovary regularly, most people will bleed every 21 to 35 days. Some women continue to have irregular menses throughout their lives. If the egg is fertilized by a sperm from a man, a baby will begin growing in the uterus and the woman will not have a menstrual period.

Q. Can I take a bath and swim when I am bleeding?

A. Yes. Taking a bath, swimming in a pool or in the ocean will not cause an infection or any harm to you while you are on your menstrual period.

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