Menstrual Bleeding - Normal Periods

Menstrual bleeding is a normal part of periods, and periods are a normal part of puberty.

Normal menstrual bleeding means your child is having periods on a regular basis.

• Being regular means the periods are occurring about every 21 to 35 days, or 28 days on average.

Bleeding normally lasts 3 to 7 days.

• It's normally less at the start, more in the middle, and less at the end, but this may vary. That is okay.

The average age of starting a period is around 12 years old, but it can range from 8 to 18 years of age.

• It usually starts about two years after breast development starts.

• Healthcare providers recommend evaluation if your child has not had their first period by age 15 years old.

Your child may have irregular periods for the first one to two years, and this is normal.

• It can take a couple of years until the hormones settle into a pattern that causes more regular periods.

Menstrual bleeding is caused by changes in hormones as your child grows.  

• These hormones come from the brain and act on parts of the female reproductive system called the uterus and ovaries.

• These hormones make the lining of the uterus thicker because every cycle the uterus is preparing for a possible pregnancy.  

  • When pregnancy does not occur, the uterus needs to get rid of the lining, and that is where the “period” or bleeding comes from.

The color of the blood may vary from bright red to dark red to brown and may have clots in it as well.

• Clots are usually smaller than a quarter.

Your child may complain of pain in the abdominal area or lower back, and this is most likely due to cramps.

• Cramps are rare the first year of their period.

• Cramps happen because the uterus has to contract to get all of the lining out, which is the period bleeding.

• The cramps may be mild or extreme, and are usually experienced the first two to three days of the period.

• Cramps usually start after the first year, and they occur in over 60% of kids with periods.  

Your child may have diarrhea, constipation, vomiting, nausea or bloating.

You may notice mood changes with their periods.

• Mood changes can vary from irritability, insomnia, anxiety, and depression to anger.  

• The mood changes may be subtle or drastic.  

Your child may notice some pimples or acne around the time of their period.

Your child may have breast tenderness.

Since blood loss is a normal part of the menstrual cycles, this means your child is also losing iron.

• In some kids that have heavy periods, the blood loss can lead to anemia, meaning low iron, where your child is low in the amount of red blood cells their body needs.

• If your child has anemia, they may have dizziness, feel more tired than is normal for them, or faint.

• Your child should be seen by their CPCMG provider if you have noticed these symptoms.

• Click here for more information about anemia and iron-rich foods.

Encourage your child to stay active.

• The more movement, the better their body will feel as it helps with all of their period symptoms.

• Yoga and stretching can be helpful as well.

Heating pads can be used on the abdomen and pelvis.

• Make sure that your child never falls asleep with a heating pad on them, as it can cause burns when not used properly.

Warm showers or baths can be soothing.

Ibuprofen (Motrin, Advil) can be helpful, especially when started a day before symptoms as it helps with cramping.

Acetaminophen (Tylenol) can be helpful as well as other menstrual medications that are available over-the-counter.  

A common over-the-counter medication is called Midol, which contains Acetaminophen, Caffeine, and an antihistamine called Pyrilamine. Midol can be used for children 12 years of age and older.

• Be sure to contact your child’s CPCMG provider if you have any concerns about what your child can and cannot use for medication.

They should continue to go to school. If missing school due to periods, please call to make an appointment to further discuss their symptoms.

• There are other medications that can be prescribed to help with periods, so please contact your child’s CPCMG provider to find out more if you feel this would be of help to your child.

Many products absorb blood so that your child can continue their normal activities.

• Here are some examples of products that help:  

  • Pads stick to the inside lining of the underwear and can be changed as often as needed depending on how much bleeding occurs throughout the day or night.

    • There are different types of pads for different levels of bleeding from light to heavy.

  • Tampons are inserted into your vagina and come in different types, from light to heavy.  

    • Tampons can be helpful for many activities like swimming and need to be changed at least every 8 hours.

    • Changing them every 4 to 6 hours is a better approach as it helps reduce the odor from blood, risk of infection, and irritation.

  • Menstrual cups that are flexible and reusable are inserted into the vagina to catch and stop the blood flow from leaking.

    • It should be taken out no later than every 12 hours and sooner if needed.  

    • It can be rinsed with water and a gentle, non-scented, oil free soap and put back in place.

    • In between periods to prepare it for next use, boil it in water for 3 to 4 minutes, or as directed by product instructions.

  • Period underwear is another option that can be used in place of pads or tampons or in addition to tampons to help with any additional bleeding.

    • Be sure to change as needed and follow packaging instructions for how to clean them.

                                               Example of a menstrual cup below:  

      

                                                  Example of period underwear below:

      

Your child has not had their first period by age 15 years old.

Your child’s period has lasted longer than 7 days.

Periods are occurring more often than every 21 days.

Your child goes more than 3 months between periods.

Your child is soaking through more than 6 pads or tampons per day.

You are concerned about the amount your child is bleeding.

Your child has felt faint or passed out during their period.

Your child’s pain is increasing, severe, or keeping them from going to school.

You have any other questions or concerns.

You would like to have your child seen.