It's one of those hallowed mother-daughter moments: Talking about menstrual periods.
There's something exciting about it; periods are part of the passage from girlhood into womanhood. Yet it's a conversation that makes many parents — usually moms or female caregivers as most men don't want to touch this one with a ten-foot pole — anxious. They aren't sure when to have the conversation. They worry about scaring their daughter. And they aren't sure what information is necessary. And because periods are related to reproduction — and therefore sex — it's a conversation that makes many people uncomfortable. Here are some tips to help, based on my experience as both a pediatrician and a parent.
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When Is the Right Time To Talk?
It's hard to accurately forecast when the first period will come, but you can get clues from watching your daughter's physical development. It's getting closer when her breasts have developed to the point where she needs a bra, and when she has a reasonable amount of pubic hair, not a few wisps. Another sign of approaching menstruation is a thin whitish vaginal discharge, which she may notice on her panties. You may still have months and months after these signs appear, but it's a good idea to get your daughter prepared.
Many schools talk with students about puberty, usually during fifth grade. Personally, I think it's a good idea for parents to bring up the subject first. But some parents are so uncomfortable, they'd rather let somebody else provide the details and then just answer questions afterwards. Either way, it's a good idea to ask the school when it will be teaching about puberty. Most likely the school will let you know ahead of time, but you may not get much warning.
Sometimes you end up having the conversation earlier than you expect. With my eldest, it came very unexpectedly, when she was 10. We'd talked about where babies come from (after she and her younger brother came home from school with some very interesting misinformation they heard at recess), but we hadn't talked about periods yet. We were in a public bathroom with the daughter of a family friend. As we waited, Michaela explored the bathroom, and became fixated on the sanitary napkin and tampon dispenser. She wanted to know what they were for, and she was not going to settle for a vague explanation. So, once we were alone, I told her about periods.
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What Do I Say?
Give her the facts. Periods are much easier to explain if, like Michaela, your daughter knows that babies grow in the uterus as opposed to being dropped off by the stork.
You don't have to get into graphic detail with children; just give them the basics with the appropriate anatomic terms. A great book to use is It's So Amazing! by Robie H. Harris and Michael Emberley.
Many girls come into my office knowing that periods mean monthly bleeding — but nothing else. If their moms want me to, here's what I do:
I draw a picture (sometimes on the exam table paper) of the ovaries, fallopian tubes, uterus and vagina (nothing fancy). I review where these are in her body. I say, "Every month one of the ovaries sends an egg down the tube to the uterus — and every month the uterus gets ready for the egg in case there is going to be a baby. This getting-ready process is like making a nest.
The egg comes down and looks around for a sperm to make a baby. I don't go into detail here about how a sperm would get there unless the parent has asked me to (I talk with them separately), but it's not a bad idea to give a brief explanation if you haven't done so. What I always make clear is that I don't expect the egg to find a sperm for many years to come! "When it doesn't find one, it passes out of the body through the vagina — and so does the nest. Once the nest is gone the body starts making a new one — waiting for the next time the egg comes."
If you like, you can explain that the reason why women don't get their period when they are pregnant is because the nest is being used.
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Calm Her Fears
To avoid scaring your daughter:
- Don't use terms like "curse." Be positive.
- Reassure her that it doesn't hurt. Some cramps are possible, but they are uncommon in the first year or so. Medications like ibuprofen can help.
- Reassure her that blood is unlikely to come gushing out on the first period. If she notices it in the school bathroom, for example, some toilet paper in the panties will do the trick until she can get a pad.
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- Teach your daughter how to open up a sanitary napkin and put it in her underwear. Let her practice. Buy a little zipper case, put a couple of napkins inside, and have her keep the case in her school backpack. Make sure she knows where you keep napkins in the house, and remind her that the school nurse always has a stash.
- A word about tampons. Ultimately, using or not using them will be a personal and family choice. (Some people think that their daughter will lose her virginity by using a tampon — this is not the case!) Pads are easier at first, obviously. But if your daughter needs or wants to go swimming, or needs to wear a tight-fitting leotard, a tampon is very useful (and many people find them preferable to pads). Look for the very slim ones with plastic applicators, as they are easiest to insert. Buy a box and let your daughter practice. You may need to help, or at least orient her. (I would save this practice for after your daughter gets her period.)Remind her to change them at least every few hours. (The slim ones don't hold much, anyway.)
- Get her a calendar and have her mark off the first day of bleeding each month. Periods can be very irregular for the first year or two, but it's good to get into the habit of keeping track of them.
Approaching periods in a matter-of-fact, positive, practical way not only helps your daughter feel prepared and good about her body, it can be a nice bonding experience for the two of you. Plus, it will get you ready for the even tougher topics — sex and birth control, for example — to come!
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Claire McCarthy, M.D. is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.