Normal Teen Menstrual Cycles: When to See a Gynecologist

While entering puberty is a natural part of growing up, the physical changes it brings can be unsettling. For those who menstruate, experiencing a period for the first time can raise a lot of questions about whether what’s going on is normal or not. As pediatricians who specialize in gynecology and blood conditions, we’re here to help you and your child navigate and understand those early cycles.

When do teens and preteens typically get their first periods?

Most adolescents get their first period between ages 10 and 15. Twelve is considered an “average” age for menarche — the start of the menstrual cycle. Some individuals may find that they begin their period around the same time that other family members had theirs, but this is not always the case.

What are the signs of a first period? What are some of the common symptoms?

For many people, their first period comes as a complete surprise, but there can sometimes be signs that it is arriving, such as pimples, bloating, mood changes or cramps. Usually, a first period is preceded by other puberty symptoms, such as the growth of pubic hair, breast development, and body shape changes.

A first period may be light or heavy right away, and period blood can range in color from brown to dark red. First periods can include many of the usual symptoms of a period, including cramping in the abdomen, back and upper legs, bloating, acne, breast tenderness, mood and sleep changes, and digestive issues such as diarrhea.

Often, when a person begins menstruating, their cycle doesn't become regular right away. For the first few years, it may begin at a different time of the month, or a person may experience different premenstrual or menstrual symptoms, including heavier or lighter bleeding. For most people, their cycles get more regular with time, and the onset and symptoms become more predictable.

Understanding the Menstrual Cycle

A visit with a pediatric and adolescent gynecologist can help teens and preteens learn about the menstrual cycle and what is considered normal or abnormal. Many times, this can be an opportunity to offer solutions for issues such as:

• Heavy or irregular menstrual bleeding
• Painful menstrual cramps
• Premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)

What should I do when my child starts their period?

It is best to be prepared for your child’s first period by having menstrual hygiene supplies in the home, and discussing what they should expect to experience before their period begins, so that it is not a complete surprise. Make sure they understand what causes a period, what kinds of symptoms they might experience, and most importantly that they know that periods are a normal and healthy part of having a female body. You might wish to put together a “period preparation” kit that they can keep in their locker or backpack, with a couple of menstrual pads, wet wipes and a clean pair of underwear, in case their first period arrives while they are in school.

It can be helpful to “celebrate” or mark the first period in some significant way, such as with a card, a favorite sweet treat, or an at-home spa night. If your child is interested, you might also consider a larger celebration, such as a party or sleepover with your child’s friends. The key is to help your child view this transition toward adulthood as a positive and natural event, not something that is shameful or embarrassing.

You can offer your child their choice of hygiene products. Common options include pads, tampons, and menstrual cups. Often, those getting their first periods find pads to be the easiest and most comfortable option. Tampons and cups can be good options for those who are active in sports, but can take some time to get used to inserting and removing. It’s important to note the instructions provided by the product of choice, as there are limitations on how certain products can be used — for example, a tampon should not be left in for more than 8 hours due to the risk of toxic shock syndrome. Help your child understand the differences between the options and choose one that works best for them.

Offer comfort measures such as child-safe painkillers and a heating pad or hot water bottle for cramps, comfort foods and emotional support if they are experiencing mood changes or food cravings, skincare products for acne outbreaks, and space and time for honest conversations.

Personal Health and Hygiene Education

The first visit not only provides an opportunity for teens and preteens to ask their questions, but it also gives the gynecologist a chance to offer important, age-appropriate patient education.

General topics covered during the first visit may include:

• Basic hygiene
• Normal versus abnormal vaginal discharge
• Puberty
• Menstruation

Wellness Exams and Assessments

Depending on the patient’s individual needs, the gynecologist may:

• Discuss physical and emotional development
• Review medical history
• Perform a basic pelvic exam and/or breast exam
• Offer possible solutions to address symptoms or other concerns

It’s understandable that teens and preteens may often feel anxiety, nervousness or even fearful about wellness procedures, such as their first pelvic exam or breast exam. Although, these exams may be performed under certain circumstances at this age, they typically become routine at age 21. When an exam is necessary at a younger age, starting with a pediatric and adolescent gynecologist is ideal, because we offer unique expertise in providing the best gynecologic care possible for children, adolescents and young adults.

Our goal is to make the experience as positive as possible, helping our patients to understand the benefits of routine wellness and preventive care at an early age.

HPV Vaccination

Teens and preteens can also get the HPV vaccine at their gynecologist’s office. The HPV vaccine helps protect adolescents from developing the human papillomavirus (HPV), which is known to lead to more than six types of cancer.

The Centers for Disease Control and Prevention recommends two doses of the HPV vaccine: the first between ages 11 and 12, and the second six months later. If the child waits until age 15, they will need three doses of the vaccine.

Sex Education

It may be difficult for an adolescent to talk to parents, guardians or other adults they know about sex. However, it is imperative that they have an opportunity to have these conversations with someone who can provide accurate information. A pediatric and adolescent gynecologist can answer questions and provide education about topics such as:

• Sexually transmitted infections
• Birth control and pregnancy prevention
• Safe and healthy intimate relationships
• Gender identity
• LGBTQ+ topics
• Having sex for the first time

How early is “too early” to start menstruating? When is “too old?"

While the average adolescent will get their first period sometime between the ages of 10 and 15, having an earlier or later first period is not necessarily a sign that something is wrong. Some children may have their first period when they are just 8 or 9 years old. Similarly, some people might not get their period until they are 15 or 16, especially if other female family members were “late bloomers.” Children usually have their first periods about two to three years after their breasts begin to develop and between six to 12 months after they begin to experience vaginal discharge; these can be helpful signs to watch out for if you are concerned whether your child is too old or too young to be experiencing their first period.

If your child begins to show signs of puberty before about the age of 8, such as developing breast buds, make sure you help them understand the changes in their body, and consider making a visit to your pediatrician. Your child may be experiencing early puberty, and a healthcare provider can help you determine whether or not there is anything to be concerned about. Similarly, if your child has reached age 15 and has not yet begun their period, consider making an appointment. Factors such as weight (too low or too high), stress levels and exercise frequency and intensity can influence when a child begins their menstrual cycle.

As your child continues to go through puberty, consider making them an appointment with a gynecologist. These specialized providers can provide education and care for your child’s growing body and help them understand the changes they are experiencing. This first appointment is focused on patient education and does not typically require a pelvic examination.

What are the signs of an abnormal period, and when should we talk to our pediatrician?

Abnormal periods can be caused by everything from lifestyle factors such as stress and exercise levels to underlying medical conditions such as a bleeding disorder or hormonal abnormalities. It can take a few years for the menstrual cycle to stabilize, so it might not be obvious right away if your child is experiencing abnormal periods, but there are some signs that you can watch out for.

Make an appointment for your child to see their pediatrician if you observe any of the following:

• Reaching the age of 15 without having a period
• Having a period before the age of 8
• Experiencing irregular cycles more than two years after starting their period
• Experiencing very heavy bleeding (bleeding through a pad or tampon in an hour or less) or severe cramps that don’t improve with painkillers
• Having very long periods (bleeding for more than a week)
• Experiencing severe PMS symptoms that make it hard for your child to get through their day

These symptoms don’t necessarily indicate that anything is wrong, but it’s good to speak with a healthcare provider just to make sure. A healthcare provider can help you and your child determine what next steps need to be taken to ensure their health and wellbeing.

If your child also has other types of bleeding such as nosebleeds, frequent gum bleeding, easy bruising or bleeding after tooth extraction or surgery, or any family history of bleeding, you may want to discuss with your pediatrician whether testing for an inherited or acquired bleeding disorder is needed.

What should I do if my child is experiencing unusual bleeding?

If your child does need additional care due to abnormal periods, the University of Chicago Medicine Comer Children's Hospital has resources that can help. We have providers who specialize in pediatric gynecologic care, to help adolescents feel comfortable and safe in their changing bodies, as well as a clinic that specializes in treating blood disorders in young adults. The Heavy Menstrual Bleeding Clinic is a multi-disciplinary clinic where patients can see a pediatric gynecologist and a pediatric hematologist at the same convenient appointment.

Menorrhagia is the clinical term for heavy periods. Very heavy periods can sometimes be a symptom of an inherited bleeding disorder, such as von Willebrand disease. Very heavy periods also can also contribute to anemia and other health issues. Our providers deliver specialized care to determine if there are underlying causes of a very heavy period and work with families to determine what treatment options will work best for them.

Diagnosis and Treatment for Gynecologic Conditions

For teens and preteens who have gynecologic conditions or symptoms, forming a doctor-patient relationship connects them with an expert who is poised to provide the specialized care they need. Pediatric and adolescent gynecologists are trained to manage the intricate health needs of children, teens and young adults who have:

• Complex chronic gynecologic conditions
• Physical or mental disabilities, such as Down syndrome or cerebral palsy
• Congenital gynecologic abnormalities (conditions present since birth)