Puberty is the time in your child’s life when they transition from a child to an adult. Special hormones are produced and released that trigger the signs of puberty. Girls between the age of 9 and 11 years usually develop certain physical changes in their bodies over time.
These include a slight increase in the breast size and appearance of body hair in the armpits and private parts. These changes usually start about two years before the first period. Also, there may be increased vaginal discharge just before the first period. Sometimes, crampy pains occur before the bleeding appears.
Girls in the age group of 8-9 years often have questions when they see an ad on TV about sanitary pads.
It would be prudent to tell her about the changes that the body undergoes in terms of breast development, hair growth, increase in height, change in the body shape and emotional changes etc.
Regarding the first period, it would be important to tell her to expect some bloody discharge on her panties or in the toilet and reassure her and say it is a normal phenomenon of growing up and is an important event in her development into a mature woman. Showing her pictures of the uterus and ovaries (in her biology textbook) would help her understand better.
The uterus is the organ in the lower abdomen which has a lining that develops due to hormonal changes occurring during this age.
When there is a certain change in the levels of these hormones, the lining is shed as a period. There may be pain associated with this as the muscle in the uterus contracts and also the small arteries in the uterine muscle get squeezed. This usually happens during the flow. However, if there is only pain and no external bleeding every month, this would need to be evaluated by a gynaecologist to look for any obstruction to the flow.
There are chances that their cycles may be very irregular since the first period. Hormone signalling from the brain to the ovaries and the uterus takes some time to mature. Hence the cycles during the first two years following the first period (menarche) may be irregular.
They usually normalise to a regular cycle lasting anywhere between 21-35 days over time. However, on average, girls gain a lot of weight during this time or develop excessive facial hair and pimples which may need to be evaluated by a gynaecologist. There are often some adolescents who may not have periods for three months and then bleed continuously for 10 days. This can happen during puberty when the hypothalamic-pituitary-ovarian (HPO) axis is still immature. The bleeding that happens after a long gap can be heavy and associated with clots that can make her anaemic. If the flow is very heavy or prolonged, it would be ideal to evaluate her to look for any anaemia and treat her for the heaviness with simple medications.
Sometimes the flow may be very heavy with big clots and your child may feel very tired.
If the flow is associated with clots, it usually is heavy. In general, the entire menstrual flow is about 20-50 ml. If it exceeds 80 ml, it is said to be heavy. Since menstrual blood flow cannot be measured, a rough guide would be to look for soaking a large pad completely every two hours or; passing clots; flooding in the toilet; staining bed linen; feeling tired or having palpitations (hearing one’s own heartbeat). If this is the case, it would be prudent to check for any underlying causes of heavy bleeding such as bleeding or coagulation disorders, thyroid problems, anaemia (low Hb) etc. An evaluation by a gynaecologist is essential and treatment in the form of simple medications such as tranexamic acid, mefenamic acid or even a short course of hormones may be considered. Is there a need for a special diet? Eating at regular intervals, drinking plenty of water, avoiding sugary and fizzy drinks, avoiding HFSSS foods (high fat, sugar, salt, spice), eating plenty of greens and citrus fruits, taking an iron-rich diet (dry fruits, greens, millets etc) works best during this period.
(The author is a senior consultant obstetrician & gynaecologist.)