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13:41 PM

Period Talk: What’s Normal, What’s Not and How To Go with The Flow

Let's Learn About ... Menstruation and Puberty from Dr. Diane

Let’s talk about periods.

Aunt Flo. The Red Tide. Shark Week.

I know. Everyone’s favorite topic.

If you have a daughter, I know it’s crossed your mind. "Is my kiddo’s body normal?" "This seems too young!" "What if she has questions?" "How do I start talking about this?"

Girls are going through puberty at earlier ages these days. I hear lots of theories about this in my office. Processed foods. Dyes. Hormones in milk. I haven’t read anything in medical literature that proves these theories, but we are still studying this stuff.

What most strongly dictates when a girl gets her period is her genetics. Namely, when did Mom get her period? Mother and Daughter “starting” ages usually correlate pretty closely.

And don’t underestimate the power of nutrition and body fat. Over the decades, we as a nation have become healthier, more well-nourished, and, in some cases…larger.

It is well known that fat releases a hormone that helps initiate puberty. It makes sense that the more “nourished” a population, the earlier girls’ bodies feel they are ready for reproduction.

Girls who are very lean, very athletic, or chronically ill may start periods later than others.

Girls often start to show the first signs of puberty around 9-10 years old. This is typically breast development, but sometimes pubic hair shows up first. In about 2-2.5 years, periods typically start.

Don’t worry if your kiddo isn’t following these trends – remember that many girls are healthy with a different timeline, and ask your pediatrician for reassurance at check-ups.

Speaking of checkups – they’re so important at this age. We pediatricians want to know that your daughter is developing normally and need to do a good exam to check this out. I try to talk to each girl about what to expect with her body – the changes that are coming and may be happening.

For example, it may be totally normal for girls to have normal white vaginal discharge 6-12 months prior to starting their period. I have seen many sighs of relief when I bring this up with a worried, shy preteen!

I also get sighs of relief from parents who are nervous to discuss these things. Know that your daughter may not bring these concerns up to you because they are shy or embarrassed. It’s important to initiate the conversation yourself.

I think it’s time to start talking about it even before any body changes happen, around ages 8 or 9.

Let your daughter know that breast development is normal, and happens differently in each girl. Let them know it’s okay for them to feel tender or even painful sometimes. Again, periods usually start 2-2.5 years after breasts develop. Keep this in mind and open the conversation as needed, because she likely won’t!

If your daughter asks about Mom’s tampons or pads, I think it’s OK to give a simple and direct answer like, “Those are for my period every month. They help keep me clean.”

Talk about what happens when periods start. Let them know it’s not giant gushes of blood! Lots of them are scared of it starting in school. Many girls panic, some even have to go to the nurse’s office, or home.

Go for a “test run” before it starts – teach her how to use a pad, put it on her underwear, and let her see how it feels. I can’t tell you how reassuring this can be.

Periods can be pretty irregular for the first year, sometimes even the second. Remind your daughter to keep pads in her backpack or purse “just in case”.

I don’t think many girls are ready for tampons right away. Pads are less scary and easier to deal with. As girls learn more about their anatomy and periods grow more regular, it’s fine to talk about how tampons work, and let her read the package inserts and see the pictures.

If any of this conversation seems too daunting, or too embarrassing…that’s what your pediatrician is for! I welcome the opportunity to teach young women about their bodies. It is empowering for them and can be very reassuring. But I encourage and commend parents who take the opportunity to do this teaching themselves! Open lines of communication are key.

Good luck!

Dr. Diane


Get to know Diane Arnaout, M.D.

Dr. Diane Arnaout joined the Cook Children's Willow Park practice in 2011. You can stay connected with Dr. Arnaout and the Willow Park practice on Facebook. Dr. Arnaout was born and raised in the Dallas-Fort Worth area. She attended college at Texas A&M University and medical school at the UT Health Science Center in San Antonio. She did her pediatric internship and residency at Children's Memorial Hermann Hospital and M.D. Anderson at the Texas Medical Center in Houston, TX where she served as a leader on the medical education committees. She is a board-certified pediatrician. Click to learn more.

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