A big milestone for a teenage girl is getting her first period. Typically, a young woman will start menstruating between the ages of 10 and 15 years old. The first few years of menstruation typically come with irregular cycles. But sometimes, menstrual issues continue and go beyond the usual variations of early cycles. If your teen is experiencing excessively painful cramps, missed or irregular periods, or abnormally heavy bleeding, this could be a sign that she has a menstrual disorder. These issues are common and treatable, but they can still affect your teen’s health, confidence, and day-to-day life. Here’s a few tips on what is typical and when you should call the doctor.
Amenorrhea (No Periods)
Amenorrhea is the complete absence of menstrual cycles. There are two types of amenorrhea:
- Primary – when a teen does not get her period by the age of 15.
- Secondary – when a teen who was getting regular menstrual periods does not get her period form 3 months or more in a row.
A regular menstrual cycle is having a period about once a month, but teenagers just starting their period may have irregular cycles for the first 2-3 years.
Cause
Primary amenorrhea has several possible causes including:
- genetic conditions affecting development
- hormone imbalances in the brain
- uterus, vagina, or hymen formation issues before birth
Both primary and secondary amenorrhea can also be related to:
- hormone changes (thyroid or PCOS – polycystic ovarian syndrome)
- weight loss, excessive exercise, and very low body weight
- chronic medical conditions and stress
Diagnosis
If your teen hasn’t had her first period by 15 years old or stops having regular periods for more than 3 months, she should see her doctor for a medical evaluation. Her medical provider will:
- Take a thorough medical history, review weight, and take vital signs
- Perform a focused physical exam based on medical history and specific symptoms
- Order blood work or imaging tests to help determine the cause of amenorrhea including
- Pregnancy test
- Thyroid function tests
- Hormone levels (FSH, LH, estradiol, prolactin, testosterone)
- Pelvic ultrasound
- Blood work to check for other medical conditions, including a complete blood count (CBC), inflammatory markers, and kidney function tests
Treatment
There is no one-size-fits-all treatment for amenorrhea. Your child’s doctor will help recommend a treatment plan that depends on the determined underlying cause of the amenorrhea.
Abnormal Uterine Bleeding (AUB)
Abnormal uterine bleeding (AUB) is the unpredictable timing of periods and varying amount of blood flow. Including:
- Bleeding that is more frequent than every 21 days (starting from the first day of one period to the first day of the next) or less frequently than every 45 days.
- Flow that is abnormally heavy or light.
Cause
AUB is commonly caused by anovulation – when the ovaries don’t release an egg. This is common in the first few years of a teen’s period when her cycles of hormones are still maturing, leading to irregular or less frequent periods. But, it is rare for teens to go more than 3 months between periods, even in the first 2 years. If your teen experiences this, she should see a medical provider to discuss it.
Diagnosis
Your child’s medical provider will:
- Take a thorough medical history
- Do a focused physical exam, though a pelvic exam is not usually needed or recommended to diagnose AUB.
- If needed, order tests to rule out other causes and make sure bleeding is not too heavy. This may include:
- Pregnancy test
- Sexually transmitted infection tests
- Blood count to check for anemia
- Thyroid function tests
- Measure of hormone levels may be helpful depending on the medical history
Treatment
Birth control pills can help regular period cycles, depending on the underlying cause, to help manage heavy bleeding. If irregular periods are related to anovulation, your teen’s provider may provide reassurance and recommend how to closely monitor her cycle.
Dysmenorrhea (Painful Periods)
50-75% of teens start experiencing painful period cramps within the first year or two of their period. This is called dysmenorrhea. Cramps happen because prostaglandins, chemicals released by the uterus, cause pain. Treatments can help manage these symptoms.
Sometimes, dysmenorrhea may be related to a gynecologic disorder called endometriosis. With this disorder, the tissue that typically lines the inside of the uterus grows on the outside and in other areas of the lower abdomen causing pain.
Symptoms
Symptoms typically begin 1 or 2 days before the start of the period and include:
- Severe cramps
- Occasional sharp pain in the lower abdomen, lower back, and thighs.
- Sweating
- Fatigue
- Headaches
- Dizziness
- Nausea and vomiting
- Diarrhea
Diagnosis
Your teen’s healthcare provider will:
- Take a thorough medical, menstrual, and family medical history
- Do a focused physical exam, though a pelvic exam is not typically needed. Blood work and imaging are also not typically needed for diagnosing dysmenorrhea.
- If a provider suspects that dysmenorrhea is caused by endometriosis (through a strong family history and cramps that do not respond to treatment), they may recommend further treatment or referral to a specialist.
Treatment
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are used to block the uterus from releasing prostaglandins (the pain-causing chemicals)
- Acetaminophen may also be used if a teen cannot take ibuprofen
- Some contraceptives may also be used to relieve cramps. This can include combining hormonal contraceptives, oral progestins, and the progestin injection (Depo Provera), along with the contraceptive implant (Nexplanon) and levonorgestrel intrauterine device (IUD).
Heavy Menstrual Bleeding
What is considered “heavy”?
- Bleeding for more than 7 days
- Soaking through 1 or more pad or tampon in 1-2 hours, for multiple hours
- Needing to double up protection by wearing more than one pad or a pad plus a tampon at the same time
- Needing to change pads or tampons in the middle of the night
- Passing blood-clots that are quarter-sized or larger
Cause
Heavy periods are often caused by irregular ovulation, causing the lining of the uterus to build up and lead to heavier bleeding during the period. Other causes include:
- Bleeding disorders – heavy periods can be the first sign that someone has a bleeding disorder
- Hormonal conditions – thyroid disorders and PCOS can also cause heavy periods
Evaluation
If your teen is experiencing heavy periods, she should see her medical provider to discuss her symptoms. Her provider will:
- Take a thorough medical and family history
- Possibly recommend labs to test (blood counts and iron levels) to test for anemia and check hormones to rule out other causes
Treatment
- Oral contraceptives can make periods lighter and shorter. Levonorgestrel IUDs can also lessen bleeding significantly or even cause periods to stop all together.
- Tranexamic acid is a prescription medication to treat heavy menstrual bleeding.
When should your teen see her healthcare provider about period issues?
- She hasn’t started her period by age 15
- She goes 3 months or more between periods
- Her periods are still irregular after the first 2 years
- Her periods are so heavy they require changing her pad or tampon every 1-2 hours
- Her period lasts longer than 7 days
- Her period changes and becomes irregular when it was previously regular
- Her cramps or other symptoms cause her to miss school or limit her daily activities.
Remember
If your teen’s periods seem unusual, cause her significant discomfort, or interfere with her daily life, contact her medical provider. The key to helping your teen feel better is early evaluation and treatment of her symptoms.