Blog of the Society for Menstrual Cycle Research

Menarche on Degrassi: The Next Generation – Emma’s Dilemma

September 30th, 2015 by David Linton

Emma and Manny from Degrassi: The Next Generation

Menarche month began at re: Cycling with reference to the brilliant first period talk Roseanne gave her daughter Darlene in a 1989 episode of Roseanne. We’ve chosen to end it with another TV reference from the beloved Canadian series of series named for the fictional street near which it is set–Degrassi. 

The word “menarche” is commonly defined with reference to the biological changes that occur within a female’s reproductive system at the point when the menstrual cycle begins to function. However, the onset of menstruation is also a social occurrence that has been layered with significance in every culture and time. In contemporary societies with “advanced” media of communication, menarche has been depicted in a wide variety of ways, sometimes reflecting prevailing taboos and superstitions, and at others in ways that are informative or even liberating. The focus is often on what I have labeled “menstrual transactions,” that is, the way interactions with other individuals, frequently boys or men, structure the meaning of menstruation for both the girl and others in her surroundings. This post explores one example of how this transitional moment in a girl’s life has been represented in a broadcast television series.


Emma’s Dilemma

One of the most positive and explicit portrayals of a girl’s first period appeared in the popular Canadian series directed at a young audience, DeGrassi: The Next Generation. Emma, the main character in the series, a girl known for her activism and responsible behavior, gets her period while sitting outside of school talking to her best friend. She is wearing a light-colored skirt and in several shots a bright red stain is visible on the back. On this particular day Emma and her friend, Manny, are scheduled to give an oral book report in front of their class and the only thing they can find for Emma to wear is a pair of gym shorts that are much too large for her. As they give the report, two young boys sitting in the front row tease her for her baggy shorts asking, “Has Emma peed her pants?”  She silences and stuns them by frankly responding, “No, I just got my period, for the first time.” They shrink in their seats. However, a somewhat more mature boy sitting in the back of the room, one who Emma has a flirtation with, is aroused from his torpor to a state of interest and appreciation for her courage as well as her implicit sexuality.

The DeGrassi clip demonstrates a rich variety of menstrual transactions. Emma’s close girlfriend comes to her rescue and even another girl, who is normally antagonistic toward Emma, gives her a pad and some “womanly” advice. Menstrual needs supersede social competition or status differences–a classic case of menstrual bonding. Perhaps most interesting is the behavior of the boys. The two young kids who tease Emma are silenced and stunned by her blunt assertion. I think of this as an effective use of her WMD–her Weapon of Menstrual Destruction. In contrast, the more mature boy, appreciates her for her assertiveness.

Missing from the four-minute clip of the transaction described above is an earlier scene in which Emma and her mother are seen walking through a shopping mall eating ice cream cones where a leering man says as they pass, “Hmmm, I’d like to lick that.” Emma shrinks away but her mother turns and confronts the man saying, “Don’t you ever talk to a woman that way!” The scene acts as a role modeling moment for Emma who replicates it in her response to the teasing boys.

Unfortunately, not all TV menarche moments are this positive. But let’s hope for more first period talks from moms like Roseanne and more socially significant, self-structured menstrual experiences from girls like Emma.

David Linton is an Emeritus Professor at Marymount Manhattan College. He is also Editor of the SMCR Newsletter and a member of the re: Cycling editorial board. His research focus is on media representations of the menstrual cycle as well as how women and men relate to one another around the presence of menstruation.

Menarche and the Growing Up of Menstrual Cycles and Ovulation

September 28th, 2015 by Editor

Guest Post by Dr. Jerilynn C. Prior, UBC, Centre for Menstrual Cycle and Ovulation Research

16-year-old Jody is anxious to talk to someone. This is what she wants to say:

“My period is out of whack!  I never know when it is coming. I only get it a few times a year. . . . Is that normal?”

To answer Jody we need to ask her how old she was when her period started. In asking that we’re trying to figure out how far she is into the normal process that our cycles must go through before they are fully mature. What she describes is perfectly natural for the first year after menarche. But if her period came when she was 11 (meaning she has a gynecological age of 5), she’s experiencing something that needs careful consideration. In this post, as someone who has studied menstrual cycles for at least 30 years  and who cares deeply that all girls mature into normally menstruating and ovulating women, I’ll ask the questions that Jody might ask, and answer as honestly as the evidence allows.

Menarche is a marker of our entry into womanhood. But it is not the start of our reproductive maturation. It is rather one lone step on a reproduction growing up pathway that has been going on for several years already. If you are a mother/grandmother with a preteen child you will one day become aware that her/his sweat is now strong and smelly, like a hot and bothered adult. Or that there is longer, darker hair on his/her arms and legs. These changes are officially called “adrenarche” and are evidence that the sex-hormone-producing layers of the adrenal glands (that also make the stress hormone, cortisol, a salt-retaining hormone and sympathetic nervous system hormones epinephrine and norepinephrine) are now growing up and making male-type hormones.

“What’s a  normal age to start your period?”

Jody got her first period a few months before she turned 16. All her friends (at least those who didn’t keep it a secret) had gotten their periods long before then. Her parents had divorced when she was 12, she was upset because she was close to her dad and rarely saw him anymore.   

In well-nourished girls and young women the first period occurs between the ages of 10 and 14 with an average in North America of about 12.5 years. The average age at menarche is now a year or two younger than it was about 50 years ago, perhaps because of better nutrition and health care. If a girl is 14 and has no flow, this is normal if she is showing some breast development. Getting first flow after age 16 is not normal and is associated with later life risks for fragility fracture (breaking a bone with a fall from standing height). This is usually caused by stresses and is something from which she can totally recover called hypothalamic amenorrhea. Rarely is it something genetic or a disease but rather a protective response because of stress of several kinds—emotional/social, nutritional, illness or over-exercise, and often a combination of several.

We now know that Jody has hypothalamic delay of her menarche.

“What’s normal for cycles in the first year after your period starts?” 

I would like to tell you that we’ve carefully studied large random groups of girls through their first year after menarche from whole populations. However, that would be untrue. One Swiss physician and his wife collected information from hundreds of girls and women with some of them recording from their first flow until menopause. Here’s what they found in that first year: cycles were quite far apart (about 40-50 days on average), quite irregular and unpredictable (R. Vollman, 1997). In a random population study of about 300 teens ages 15-19 from Copenhagen County in Denmark, 77% said their cycles were regular (between 21 and 35 days apart), 22% said they were irregular, and 2 of 100 had not yet reached menarche or were experiencing amenorrhea (Munster, 1992).

“Will I ever be able to have children?”

Obviously, to become pregnant and to carry a pregnancy to a normal childbirth, requires a grown-up reproductive system. The key part of that is ovulating, releasing an egg that could be fertilized, embed into the endometrium and eventually make a placenta and the very complex blood vessel system required for a healthy baby. So what’s normal for ovulation in the first year after menarche? Susan Barr (professor of nutrition at the University of British Columbia) and I studied girls ages 9 to 11 who had not yet menstruated over two years (Barr 2001). During that time some of them got their period. When they did, we asked them to collect morning saliva one day a week and especially during the third and fourth weeks from their flow. We measured progesterone in saliva and discovered that none seemed to have ovulated until 10 months from menarche (Kalyan, 2007).

Vollman, in studying young women from after their first menstruation, found that fewer than four of any 10 cycles showed evidence of ovulation during that first year (Vollman, 1977). That rare ovulation, however, was unlikely to support a pregnancy based on a Canadian study of exercising teens ages 15-19 and averaging 2.5 years after menarche. It showed that these young women might have regular cycles and that they often ovulated, but that the luteal phase (the length of the time after ovulation until flow) was very short (Bonen 1981). It takes many days for progesterone, produced during the luteal phase, to transform the endometrial uterine lining into something secretory that supports a fertilized egg. If the adult and fertile luteal phase length is 10-16 days, as evidence suggests, these teens experienced luteal lengths of 4-8 days (Bonen, 1981) that would not be fertile.

#MenarcheMonth Redux: Weekend Links at re: Cycling

September 26th, 2015 by Laura Wershler

September has been #MenarcheMonth at re: Cycling, and as it draws to a close–just two posts left to come in the menarche series–I thought I’d collate the links to the full range of topics our contributors have covered this month.

I kicked it off by paying homage to one mom’s first period talk with her daughter from a 1989 episode of the hit TV series Roseanne. Watch Roseanne set the right tone with her daughter Darlene in #Menstruationmatters and it starts with menarche.

Menstrual designer Jen Lewis’s Ms. September–Menstruation Pin-up was titled Let it Flow #2.

In Weekend Links we featured first periods stories and a short list of people and organizations talking about menstruation on Twitter.

Dr. Lara Briden’s post about Why young teens need real periods–not the pill generated the liveliest response with 33 comments. If you haven’t read it yet, please do, and share your thoughts about what Briden, a naturopathic doctor, and other commenters had to say on the topic.

PhD student Saniya Lee Ghanoui examined menstrual health education films in The 1970s and the menstrual dance: Naturally…A GirlMight you have been shown this film in health class? There’s a YouTube link if you’d like to watch it again.

In A daughter raise with body literacy, Holistic Reproductive Health Practitioner Lisa Leger told a unique story of how she taught her daughter about menstrual cycle charting from her first period and what she believes her daughter gained by having this knowledge.

Mother-daughter co-authors Sheryl Mendlinger, Phd, and Yael Magen, Esq., read a passage from their book in A poignant first period story from the book Schlopping. In a subsequent post Mendlinger shared what she learned from immigrant women about their menarche experiences in How do mothers pass on knowledge about menstruation to their daughters?

Suzan Hutchinson informed us about precocious puberty in What happens when a seven-year-old gets her period? Her piece makes clear that neither society nor our elementary schools are as prepared as they could be, or should be, to support girls experiencing early menarche.

Be sure to check out the final two post in the September 2015 #MenarcheMonth series.

Laura Wershler is a veteran sexual and reproductive health advocate and writer, SMCR member, and editor-in-chief of re: Cycling.

What happens when a seven-year-old gets her period?

September 24th, 2015 by Editor

Guest Post by Suzan Hutchinson

Do you remember being seven years old? Engage your imagination for a few minutes and try re-entering your seven-year-old world. Remember what fun life was. Recall what grade you were in, and what you enjoyed about school. Reconnect with your friends and with a few special memories.

Photo provided by Suzan Hutchinson

Menarche is not a word in a seven-year-old’s vocabulary, but there are girls who experience their first menstrual periods at age seven or even younger as a result of precocious puberty. Leaving aside the multiple medical causes of such early onset, let’s focus on how this pubertal milestone differs for those among us who experience precocious puberty. While no two experiences are identical, some of the common realities include:

  • Discovering blood on your underclothing or on toilet paper, then, at best, not being able to figure out why you are bleeding since you did not cut or hurt yourself, or, at worst, being scared you are bleeding to death
  • Having adults treat you differently from your peers, sometimes because they know you are menstruating, other times because they expect you to be able to do things a much older child would do because physically your body appears older than its chronological age
  • Learning new hygiene habits, like how to wear, change, and dispose of pads (nearly all girls who start this young begin exclusively with pads or a combination of pads and liners)
  • Navigating a world that doesn’t account for seven-year-olds who are menstruating, including schools that don’t accommodate children who might need to carry purses or other items into the bathroom, or provide bins in bathroom stalls for disposing of used products
  • Feeling isolated and alone with parents and other adults constantly telling you what to do, when, and how, while also being reminded that it is private and that you cannot tell your friends about your bleeding

This is challenging enough, but it is only the tip of an iceberg. While there are some helpful resources for parents to help their daughters with these practical issues related to menstruation, there are no easy answers to managing the moodiness or easing the emotional edges while dealing with other hormonally driven changes.

Because of these and other challenges, some families choose medical intervention to halt pubertal progression and suppress menstruation until their daughter is older. This response is also the default with preschool-aged girls and an option for any girl who is diagnosed with precocious puberty.

For those families that do not intervene, menarche will be her first of many childhood menstrual periods. In most cases these girls menstruate for several years before they can comfortably confide in peers who are then experiencing their own menarches.

Whether or not your family is ever directly impacted by precocious puberty, it is important that you have a general awareness. Here are some key facts about menarche in the United States:

  • For girls, puberty starts well before menarche. For most girls the onset of puberty is first evidenced by the development of breast buds (pubic hair appears first for the rest). If your daughter has breast buds before age seven, pubic hair before age eight, or menarche before age 10, then it is worth discussing this early development with her pediatrician and, quite likely, she receive a referral to a pediatric endocrinologist for further evaluation.
  • It is also important to know that normal puberty starts in girls at a younger age than most parents expect. Today, more than 1 in 7 (15%) American girls start puberty at age seven, and that number climbs to more than 1 in 4 (28%) by age eight. And while the average age of pubertal onset continues a decades-long decline, the average age for menarche has been much more stable. Today the average African-American girl will start puberty at age eight years, nine months; the average Hispanic girl at age nine years, three months; and the average Asian American or Caucasian girl at nine years eight months. Among all girls, the average age for menarche is now around 12 years, six months.

Do you remember much about second grade? Whatever you remember, remember that girls with precocious puberty often have some rather grown-up memories by the time they are in the second grade.

Suzan Hutchinson, a menstrual educator, coach and activist, is the founder of Period Wise. She works for Lunette and has held multiple volunteer roles with the Toxic Shock Syndrome Awareness non-profit organization You ARE Loved. Follow Suzan on Twitter @periodwise and like PeriodWise on Facebook.

How do mothers pass on knowledge about menstruation to their daughters?

September 21st, 2015 by Editor

Guest Post by Sheryl Mendlinger, PhD

The impetus of my research on menstruation started many years ago when my daughter Yael was in her teens in the 1990s, and came home from school and told me that her friends said, “If you use tampons you could lose your virginity.” Therefore, none of them were using tampons. We lived in a diverse community and many of her friends’ parents had immigrated from North Africa, Iraq and Europe to Israel. I started thinking that what we learn from our mothers, especially about menstruation, can impact our lives in so many ways. Years later when I chose my topic for my PhD, I examined mother-daughter dyads from North Africa, Ethiopia, Europe, North America, the Former Soviet Union, and Israeli born, in order to better understand how mothers transmit knowledge about health behaviors, specifically about  menstruation, to their daughters.

Photo of a menstrual hut provided by Sheryl Mendlinger

A model of knowledge acquisition for learning about menstruation was developed that included:

  • Traditional knowledge—informal knowledge passed through the generations
  • Embodied knowledge—observing others or experiencing oneself
  • Technical knowledge—the products used, and
  • Authoritative knowledge—learning from books, professionals, etc.

One of the most interesting aspects of this research is the stories the women shared about their menarche experiences. Certain celebrations that have continued through the generations may give either a positive or negative valence to the way women view menstruation. Traditional knowledge and rituals often provide strong emotional support for daughters allowing a comfortable transition through this key developmental stage. Several women whose origins were from Europe spoke about “the slap.” One mother told the story that when she got her first period her mother slapped her across the face, which she did to both of her daughters. The mother said the reason was something about the blood coming back and the daughter said it was something about the blood not going to your mind. The actual historical reasons for the slap vary and include: the manner in which it was performed could determine the duration of menstruation; it was necessary for a girl when she becomes a woman as protection against disgrace; and the rush of blood will make the girl have a wonderful color of her life. Often the rituals continue, but the rationale for the tradition has been lost.

The older Ethiopian women talked about their experiences at menarche which included special foods that their mother’s prepared, and then the young girl would go to the menstruation hut where she would stay until the completion of her period and be pampered by other women of the community. Women often looked forward to that time as a fun week away from chores and a brief vacation from everyday life, and a time to be with their women friends. As one woman said “In Ethiopia there is no rest until you go to the hut; only during menstruation does the woman rest.” The mothers however did not continue these traditions, even preparing special foods, following immigration to Israel.

The older women born in North Africa spoke with joy and excitement when they reminisced about getting their periods for the first time and the celebrations that surrounded this event. Their mothers were an integral part of this transition in life from child to woman. Some of the traditions included: mothers giving their daughters pieces of jewelry and preparing special foods; performing the ritual of putting three of the daughters’ fingers in flour so that they should only get their period for three days; and the oil ceremony. Mothers told their daughters to look and smile at their reflection in a bowl of olive oil, and then their faces were rubbed with oil. These girls were told that the image they saw on that day should continue and they should enjoy a happy life. The women noted that the oil would smooth a woman’s passage into womanhood. This oil ceremony was accompanied by a festive meal with traditional foods including honey-dipped, oil-fried cakes. When these women, the elders, were asked if they continued this tradition with their daughters, they all answered an emphatic no, of course not.

These special traditions and ceremonies that were so important from the past were often not continued into the next generation. It appears that the change and adaptation to the new culture and environment took precedence and provides an explanation for why these mothers did not continue these traditions with their daughters.

Recently however, there has been a movement to find positive and meaningful ways for young adolescent girls to celebrate the onset of menstruation in the western modern society. In my study there was an example of the daughter of an American immigrant who grew up on a Kibbutz, an agricultural collective community in which children grow up together in children’s homes.  She spoke with enthusiasm, excitement and had positive memories when remembering how each time a girl in her age group got their period, they would celebrate with gifts. These celebrations took place together with the girls in their age cohort rather than with their mothers.

Through this research we gained a better understanding of the influences and attitudes related to menarche that a mother passes on to her daughter, and the changes that take place following immigration and acculturation to the new society.

A poignant first period story from the book Schlopping

September 16th, 2015 by Editor


From the book Schlopping: Developing Relationships, Self-Image & Memories comes another unique mother-daughter menarche story as follow up to Monday’s post by A daughter raised with body literacy. Though completely different in many respects, both these stories convey the love and good intentions two mothers had for their daughters upon the occasion of their first menstrual period.

Sheryl Menlinger and Yael Magen are the authors of Schlopping explained as: (noun) schlep + love + shopping, a ritual of schlepping with someone you love while shopping. What’s it about? “Two completely different people,” the book’s back cover states, “who happen to be mother and daughter, find answers to life’s challenges through their invented world of schlopping.”

This duo’s differences are apparent in the tale they tell together of Yael’s first period. It unfolds in the second chapter of the book, but on this post you can watch and listen to Sheryl and Yael read this story as they took part in the Menstrual Poetry Open Mic conference-closing event at the Society for Menstrual Cycle Research conference in Boston, on June 6th, 2015.




Sheryl and Yael read from Schlopping:

Dahlia Lithwick, Senior Editor at Slate, says about the book:

Schlopping is a beautiful dialogue that is only nominally about families and shopping. What it truly captures is all the spaces in between: the love, the pressure, the body image, questions, illness, money, terrorism, parenting, beauty, materialism, and womanhood.”

A portion of sales of Schlopping will go to research and wellness for endometriosis and breast cancer. The book includes stories of Yael’s and Sheryl’s experiences with both.

Sheryl E. Mendlinger, PhD, is an author, advocate for women’s health, daughter, wife, mother, and grandmother. Sheryl’s expertise is inter-generational transmission of knowledge and health behaviors in mother-daughter dyads from multicultural populations with a focus on menstruation.  

Yael Magen, Esq., is a lawyer, author, public speaker, entrepreneur and mother of two young children. Yael worked in government and non-profit, and was a mayoral candidate at the beginning of her career. Today she focuses on her general law practice Multigenerational Family Law and Taxes LP where she helps families who have financial, physical, and emotional obligations to two or more generations with their finances and estate planning. 

A daughter raised with body literacy

September 14th, 2015 by Lisa Leger

Adapted from A Baby Born to Body Literacy, Femme Fertile, Winter, 2006, p. 6

Lisa Leger, a Justisse Method fertility awareness educator, with her daughter.

My daughter was born at home with midwives. Not because I was brave, but because I was chicken. Working in health care, I had heard too many maternity-ward horror stories. My studies in fertility awareness and charting my own cycles gave me confidence in my own body to do what it was supposed to do. I also trusted my baby to do her part, and felt safe with my husband and midwives by my side. She came straight to my breast and grew up nursing on demand without ear infections, fevers, constipation, or sniffles.

Her dad and I taught her how to live by explaining everything, how food was fuel, why we wash our hands and wipe our bums. We modelled a casual intimacy in the bathroom; she saw my mucus and menstrual blood. As a toddler she loved pulling the strip off my disposable pads; as a tween she wanted more privacy. The early rituals of puberty were all dealt with straightforwardly and I was full of information and eager to go into detail so my daughter was well-informed about sex and fertility compared to her peers.

When my daughter’s first period arrived shortly after her 12th birthday, the first thing I did was get a blank menstrual cycle chart and have her fill in the date of her first Day One. Since then, I have been revealing more details about the adult world, welcoming her into the “blood mysteries” with stories both mythical and personal. She learned about the back stories related to puberty and sexuality for Little Red Riding Hood, that cherries represent virginity. We watched the 1976 movie Carrie, and she was appalled that Carrie’s mother didn’t tell her daughter anything about what to expect before her periods began.

At first I helped my daughter chart her cycles, complete with mucus observations, abdominal pains, cramps and clots. I remember charting during story time as part of our evening routine. She reported sensations and mucus observations, but her main interest was in knowing when to expect her periods in relation to swimming trips or sleep-overs.

When she decided to have sex at 17, my daughter went to the public health unit and got some birth control pills from the nurse. This was probably thanks to the sex education she got in high school as much as from the human tendency to reject whatever one’s mom does.  I kept my mouth shut with difficulty until side effects appeared. She then tried the Nuvaring, unsuccessfully, and eventually settled on condoms as her birth control method. This process was more difficult for me than for her, because I had to watch as she developed gall bladder symptoms, nausea, and mood swings that interfered with her relationships until she arrived at her own decision to ditch the synthetic hormones.

My daughter has a good foundation of body literacy: she trusts that her body functions are normal, she understands charting, and she is grounded by this knowledge as a young woman of 22 years old. My colleagues will point out that few girls have the good fortune to grow up with a fertility awareness educator for a mother, but I am optimistic that every girl can learn to be aware of her fertility cycles and benefit from even a rudimentary understanding of ovulation. This is why I implored sexual health educators in another blog post–Sex Ed. for Teens: Where’s The Mucus?–to explain the role of cervical mucus in identifying the fertile time.

Research evidence suggests that fertility awareness education leads to delayed sexual activity, reduced teen pregnancy, and lower risky behaviour. I have observed this in my daughter’s life; she has been discerning in her relationships, aware of her worth, and careful with her health. I expect that the body literacy she acquired as a child and teen will serve her well in all reproductive health events throughout her life.

Lisa Leger, B.A., is a Holistic Reproductive Health Practitioner on Vancouver Island. She teaches the Justisse Method of fertility awareness in a pharmacy setting where she works as the Natural Health Consultant. 

Weekend Links: Twitter is talking about menstruation—a lot!

September 12th, 2015 by Laura Wershler

The menstrual community on Twitter keeps growing. Individuals, social action initiatives, non-profits, menstrual product companies and other organizations are sharing information and talking about the menstrual cycle and the menstrual experience.

Here’s a short list of menstrual-related Twitter accounts you may want to follow:

@AuntFlo28 Tweets about menarche and promotes menstruation as something that should not be medicalized. She invites followers to take part in a poll asking at what age you got your period.

Via Twitter message (how else?) Kylie Matthews said, “I launched the poll as a way to gather data, but more importantly start conversations about #Menarche. For far too many women the experience was not a positive one. It is my hope that reflecting on one’s own positive or negative experiences (and ideally conversing with others!) will help move toward efforts to make things better for the next generation.”

Last Wednesday, Sep. 9, 2015, @AuntFlo28 co-hosted #Menarche_PCOS_Talk with Polycystic Ovary Syndrome advocate @PCOSGurl who includes menstrual information in her Twitter advocacy to improve education and outcomes for women with PCOS (or Anovulatory Androgen Excess).

@bpreparedperiod helps “women and girls go with the flo,” and offers resources and tips for parents to help them help their daughters prepare for menstruation.

SMCR member Chella Quint tweets @periodpositive where the goal is to be “funny w/o insulting menstruators of all genders, challenges taboos, reclaims discourse.”

Suzann @periodwise says on her Twitter profile, “Let’s end menstrual taboos right here, right now.” She tweets on all things menstrual, complemented by the Period Wise website and blog.

New on the Twitter feed is @LtsFaceItPeriod which launched the #LetsFaceItPeriod campaign on Sep. 1, 2015. You can read about the social action initiative at Lady Clever: Let’s Face It. Period Breaks Down Menstrual Taboos.

This is just a small sampling of those on Twitter talking about periods. If you follow a few menstrual communicators not mentioned here, please post their Twitter handles in the comments section and tell us a little bit about them.

Why young teens need real periods–not the Pill

September 8th, 2015 by Laura Wershler

Guest Post by Dr. Lara Briden, ND

Photo supplied by Lara Briden

The onset of menstruation (menarche) is an important time for girls. It heralds their future fertility, of course, but it’s much more than that. Menarche is also when girls start to make female hormones for the first time.

Making hormones is not easy. It requires regular ovulation, and that can take a few years to become established. That’s why the early years of menstruation are exactly the wrong time to take hormonal birth control. Yet, unfortunately, that’s when more and more girls start taking it. According to a new study [1], this decade has seen a 50 percent jump in the number of young teens (12-15 years old) using medication such as Pills, injection, implant, and Nuvaring. These girls are at risk for many of the side effects of hormonal birth control including:

  • impaired bone density [2]
  • altered brain structure [3]
  • increased risk for depression [4]
  • suppressed libido [5]

Side effects occur partly from the synthetic hormones themselves and
partly from lack of girls’ own estrogen and progesterone.

Ovulation is How Girls Make Hormones

Ovulation is not just about making a baby. It’s also the main hormonal event in a menstrual cycle, and the only way to make estrogen and progesterone. When we shut down ovulation with hormonal birth control, we rob girls of the hormones they need for metabolism, bone health, cardiovascular health, mood, and more.

Girls who take synthetic pseudo-hormones via the Pill lose the ability to produce their own hormones. Pseudo-hormones have some similarities to real human hormones, but they also have many differences. For example, the progestin levonorgestrel causes hair loss, but the body’s own progesterone stimulates hair growth. The progestin drospirenone increases the risk of blood clots, but progesterone improves cardiovascular health. Ethinylestradiol, the synthetic estrogen in the Pill, impairs insulin sensitivity [6], but estradiol improves it. These synthetic hormones do not have the health benefits of the human hormones they replace.

Pill Bleeds Are Not Periods

Hormonal birth control is often prescribed to “regulate” periods, but that is nonsensical because a pill-bleed is not the same as a real period.

A real period is the end result of a series of important hormonal events including ovulation. In contrast, a pill bleed is a withdrawal bleed dictated by the dosing regimen of the drug manufacturer.

Newly menstruating girls often have irregular or heavy periods. That can make it tempting for doctors to suggest and for mothers to agree to give them hormonal birth control to mask the problem. But irregular and heavy periods are normal at that age. They occur because girls have not yet established regular ovulation. Hormonal birth control further suppresses ovulation, and that’s why it’s exactly the wrong thing to do. Hormonal birth control won’t promote future ovulation or menstrual regularity, and will probably make it even harder to ovulate in the future.

Better Treatment for Menstrual Problems

Teens have many non-hormonal treatment options for troublesome period symptoms.

Heavy periods: Teens will usually outgrow heavy periods after a couple of years. In the meantime, they can use natural treatments such as a dairy-free diet and the herbal medicine turmeric. Short term use of ibuprofen can also be helpful. I discuss these strategies in this article on Natural Treatment of Very Heavy Periods.

Irregular periods: Irregular periods are common in the first couple of years of menstruation and they usually do not require treatment. If periods do not start to become more regular, then please seek a medical diagnosis. The best treatment will not be the Pill, but rather it will be something to address the underlying cause of irregular periods. For example, the common hormonal condition polycystic ovarian syndrome (PCOS) requires diet and exercise to normalize blood sugar. The Pill is not appropriate treatment for PCOS, contrary to what your doctor might say.

Acne: Teen acne responds extremely well to a dairy-free, sugar-free diet and to the nutritional supplement zinc. Natural acne treatments work more slowly than the Pill, but they’re a better choice in the long term because they’re a permanent cure. In contrast, the Pill’s synthetic estrogen will only mask acne for the duration that it’s used. As soon as the Pill is stopped, acne will typically return even worse than it was before.

Better Birth Control

For those teens who need birth control, there are a couple of good non-hormonal methods. The advantage of a non-hormonal method is that it permits healthy ovulatory cycles and hormone production.

  1. Copper intrauterine device (IUD): Unlike hormonal birth control, the copper IUD does not suppress ovulation or hormones. Instead, it prevents pregnancy by impairing sperm motility and implantation. It is also highly effective with a failure rate of just 0.6 percent. The September 2012 guidelines from American College of Obstetricians and Gynecologists (ACOG) state that copper IUDs are safe for women who have never had children and for teenagers. This overturns a pervasive—but unfounded—opinion that IUDs should not be used until after childbirth.
  2. Combination condoms and Fertility Awareness Method: Teens should use condoms on every occasion of intercourse. In this way, they can avoid sexually transmitted disease as well as unwanted pregnancy. Teens can also learn to recognize their peak fertile days (charted according to fertility awareness-based methods), and then abstain on the those few days per month. Strategic, short-term abstinence will greatly reduce their risk of pregnancy in the unlikely event of a broken condom. Fertility awareness also teaches girls body literacy which is important for their future health choices. For Fertility Awareness information and a list of instructors, please visit Justisse Healthworks for Women.

Weekend Links are all about first period stories

September 5th, 2015 by Laura Wershler

Let it Flow #2 by Menstrual Designer Jen Lewis. Photographer: Rob Lewis

All though the month of September we are exploring menarche at re: Cycling. Check out the kick-off post with a YouTube link to the 1989 episode of Roseanne in which mom Roseanne gives daughter Darlene first period advice that is still relevant today.

Last December The Guardian published a compendium of first period stories from readers. Sue Spillman ordered trial tampons from a magazine ad thinking it would be “easy and discreet.” Let’s just say that when the package arrived the cops got involved.

A few of the 10 First Period Horror Stories posted on Cosmopolitan suggests mothers could do a better job of preparing their daughters for menarche. Maybe I was lucky but my mother, a public health nurse, made sure I had the supplies I needed before I got my first period.

At Vice this past January, anonymous female comedians contributed their best (and worst) period stories. Most of them seem to be related to first periods. Here’s a short one that couldn’t have happened in my day:

Stephanie: My period started for the first time when I was 13 and happened to be at home. My mom was also home, but I was too embarrassed to go tell her, so I emailed her.

Several of these stories make me think we could do a much better job to prepare the girls in our lives for the experience of menarche, and provide them with more helpful guidance on how to manage the challenges that come with the onset of menstruation. I wrote about this in a 2013 blog post called How do girls learn about periods?

Gina Boothroyd shares a much different perspective in her poignant July 2015 piece for The Guardian: My autistic daughter coped with getting her first period much better than I did. Although her 11-year-old was “pleased and proud to get her period,” Boothroyd worries about what comes after menarche that her daughter may miss out on.

Laura Wershler is a veteran sexual and reproductive health advocate and writer, SMCR member, and editor-in-chief of re: Cycling.

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.