Teen periods: What's normal?
Most girls get their first period when they're between 10 and 15 years old. The average age is 12, but every girl's body has its own schedule. The average age of onset for puberty and menstruation has been getting younger. Reasons for the general trend towards earlier puberty are multifactorial with changes in nutritional status and growth acceleration being leading factors for both genders [I]. However, lifelong exposure to endocrine-disrupting chemicals (EDCs) found in some pesticides and plastics and throughout the food chain are also believed to be playing a role. These environmental toxins interfere with normal hormone function and can accumulate in fatty tissues and exert hormonal effects in the body [ii]. Reducing exposure to these compounds and supporting the body to more effectively detoxify and eliminate them can help reduce any impact they may be having on accelerating puberty and other adverse health implications they are associated with [iii].
In the first few years of menstruation, it is not uncommon to have irregular cycles. The HPO axis (brain, pituitary glands, and ovaries) need to establish their communication with each other in a way that they haven’t needed to previously. Cycles may be as short as 21 days or as long as 45 days.
Dysmenorrhea = painful periods
Dysmenorrhea can be caused by sensations of pressure in the abdomen as the uterus lining thickens leading into the menstrual bleed. In some cases, this congestive pain can radiate down the vagina and legs due to pressure of the uterus on sciatic nerves. Congestive pain is commonly relieved by heat and can be supported further with warming foods and herbs such as ginger, cinnamon, and Dong Quai (Angelica sinensis) to increase blood flow and reduce pelvic congestion.
Spasmodic pain immediately prior and during bleeding begins is most common, particularly in teenagers. This cramping pain is caused by the constriction of blood vessels in the endometrium and the contraction of the uterus which occurs to shed the uterus lining. These contractions are triggered by rising levels of prostaglandins and should occur gently and be largely unnoticeable. Higher levels of prostaglandins are associated with increased pain sensitivity and inflammation. In these cases, we can use anti-inflammatory herbs and nutrients such as ginger, turmeric, and fish oil as well as herbs to reduce spasm and pain such as Cramp Bark, Wild Yam, Peony and Corydalis. Magnesium supplementation may also be useful to regulate the contraction and relaxation of the uterus. Dietary changes can help balance prostaglandins and reduce severe cramping pain going forward.
Menorrhagia = heavy bleeding
During the first few years, oestrogen is new to the body. Hormone receptors in these early menstruating years can be highly sensitive and react strongly to oestrogen. Teen girls are also much more likely to have bleeds that are not true periods. These are the result of shifting hormones, not ovulation, and when this happens it’s called an “anovulatory cycle,” meaning “a cycle without ovulation.” Without ovulation, we do not produce the corpus luteum which is required to make progesterone. Without progesterone to counterbalance oestrogen, and with highly sensitive oestrogen receptors, some teens will experience heavy bleeding (menorrhagia) in their early cycles.
Menstrual fluid contains cervical mucous, vaginal secretions, uterine lining, and some blood. Menstrual fluid should be mostly fluid with no large clots. Small menstrual clots made up of pieces uterine lining are normal but there should not be too many and they should be no larger than 1-2cm [iv].
Over the entire bleed around 50mL of menstrual fluid is commonly lost. Less than 25mL is considered very light. More than 80mL is considered heavy bleeding. To estimate the amount of menstrual fluid you can use number of soaked tampons or pads. A regular pad or tampon holds around 5mL, and a super tampon holds around 10mL [v].
Any pain or heavy bleeding that disrupts daily function is not normal, for teens or adults!
Pain or bleeding that results in missed school should be investigated. Conditions like endometriosis are surprisingly common even in teenage years and the earlier these issues are investigated, the less impact on quality of life and fertility down the road. The average time to diagnosis for endometriosis is quoted as somewhere between 6 and 17 years!! Let’s change that statistic and look after our teens when the concerns first arise!
And heads up…...the oral contraceptive pill is not the answer. It does not regulate your periods or balance your hormones. In fact, in most cases it suppresses symptoms by shutting down endogenous hormones completely [vi] .
Pill bleeds are not periods.
The bleed that occurs when taking the oral contraceptive pill is a medication withdrawal bleed, not a period. When the birth control pill is stopped, all underlying issues that led to taking it in the first place remain.
Understanding our bodies, our hormonal cycles and the multitude of factors influencing menstruation, reproduction and fertility is incredibly empowering. If the oral contraceptive pill is being used for anything other than contraception, important warning signs are being ignored and valuable information about our underlying health is being suppressed.
In 2015, in a paper titled “Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign”, the American College of Obstetricians and Gynaecologists (ACOG) stated, “identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood” [xvi]. Hurrah! I could not agree more!
Natural solutions for teenage period pain
Reducing inflammatory foods such as processed/junk foods, refined sugar, fried foods, artificial ingredients, and in some cases foods such as gluten and dairy which can be inflammatory for some individuals.
Incorporate anti-inflammatory foods in the diet including oily fish, nuts and seeds, spices such as turmeric and ginger, green tea and plenty of fresh fruits and vegetables.
Application of heat to the area using a hot water bottle or warm bath/shower can be particularly helpful to congestive pain.
Nutritional supplementation and herbs will be individual to each person but may include the following
Nutrients Magnesium[vii] , B6 [viii], zinc [ix] and fish oil [x]
Herbs
Uterine tonics: Dong Quai (Angelica sinensis) , Raspberry leaf (Rubus idaeus) [xi]
Anti spasmodic: Cramp Bark (Viburnum opulus) , Black Haw (Viburnum prunifolium) , Wild Yam (Dioscorea villosa) , Peony (Paeonia lactiflora) [xii]
Anodynes & prostaglandin inhibiting herbs: Corydalis (Corydalis ambigua) , Turmeric (Curcuma longa), Ginger (Zingiber officinale)[xiii]
Warming herbs: Ginger (Zingiber officinale) [xiv]
Due to the immaturity of the menstrual cycle, hormone-modulating herbs commonly prescribed to adults to reduce pain or heavy bleeding are not always recommended for teens while the body finds its own rhythm and balance. Other herbs, like Yarrow (Achillea millefolium) [xv], can still be used to lighten bleeding if required.
When to seek help
- Missing school from period pain
- Large clots in menstrual fluid
- Soaking a pad in 1-2 hours
- Significant mood swings, low mood or anxiety in day(s)/week preceeding period
- Bleeding lasts more than 7 days
- Time between cycles is more frequent than 21 days or longer than 45 days
- No period by age 15 or within 3 years of developing breast buds.
As a family naturopath and nutritional therapist, I take enormous pride in supporting children, teens, and adults on all aspects of health, including investigating and addressing root cause to optimise menstrual cycles and reproductive health and where necessary working integratively with other medical professionals in order to provide best patient outcomes. If you’d like to chat about how I might be able to support your family, book a discovery call (online) or an initial appointment (face-to-face or online) to get started.
References
[i] B Aydin, E Devecioglu, and A Kadioglu, “The Relationship between Infancy Growth Rate and the Onset of Puberty in Both Genders,” Pediatric Research 82 (2017): 940–46.
[ii] Ruth Trickey, Women, Hormones and the Menstrual Cycle (Trickey Enterprises (Victoria) Pty, Limited, 2011).
[iii] Eva Rahman Kabir, Monica Sharfin Rahman, and Imon Rahman, “A Review on Endocrine Disruptors and Their Possible Impacts on Human Health,” Environmental Toxicology and Pharmacology 40, no. 1 (July 1, 2015): 241–58, https://doi.org/10.1016/j.etap.2015.06.009.
[iv] Lara Briden N.D, The Period Repair Manual, 2nd ed. (Greenpeak Publishing, 2018).
[v] Briden N.D.
[vi] Briden N.D.
[vii] Fabio Parazzini, Mirella Di Martino, and Paolo Pellegrino, “Magnesium in the Gynecological Practice: A Literature Review,” Magnesium Research 30, no. 1 (January 1, 2017): 1–7, https://doi.org/10.1684/mrh.2017.0419.
[viii] Ervan J Randabunga et al., “Effect of Pyridoxine on Prostaglandin Plasma Level for Primary Dysmenorrheal Treatment: Pengaruh Pemberian Piridoksin Terhadap Kadar Prostaglandin Plasma Sebagai Terapi Dismenore Primer,” Indonesian Journal of Obstetrics and Gynecology, October 15, 2018, 239–42, https://doi.org/10.32771/inajog.v6i4.848.
[ix] George A. Eby, “Zinc Treatment Prevents Dysmenorrhea,” Medical Hypotheses 69, no. 2 (January 1, 2007): 297–301, https://doi.org/10.1016/j.mehy.2006.12.009.
[x] Mandana Zafari, Fereshteh Behmanesh, and Azar Agha Mohammadi, “Comparison of the Effect of Fish Oil and Ibuprofen on Treatment of Severe Pain in Primary Dysmenorrhea,” Caspian Journal of Internal Medicine 2, no. 3 (2011): 279–82.
[xi] Trickey, Women, Hormones and the Menstrual Cycle.
[xii] Trickey.
[xiii] Trickey.
[xiv] Parvin Rahnama et al., “Effect of Zingiber Officinale R. Rhizomes (Ginger) on Pain Relief in Primary Dysmenorrhea: A Placebo Randomized Trial,” BMC Complementary and Alternative Medicine 12, no. 1 (July 10, 2012): 92, https://doi.org/10.1186/1472-6882-12-92.
[xv] Anna B. Livdans-Forret, Phyllis J. Harvey, and Susan M. Larkin-Thier, “Menorrhagia: A Synopsis of Management Focusing on Herbal and Nutritional Supplements, and Chiropractic.,” The Journal of the Canadian Chiropractic Association 51, no. 4 (December 2007): 235–46.
[xvi] Briden N.D, The Period Repair Manual.