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All About Menstruation

Tori, Luke, and Jenna are rushing to math class when Tori ducks into the restroom. Jenna knows Tori has her period and she's a little envious, wondering when hers is going to start - even her 10-year-old little sister has hers. What she doesn't know is that Tori has cramps and is wishing she'd never gotten her period in the first place. Meanwhile Luke, who's Tori's twin, is wondering if she's OK. He knows his sister has her period but can't imagine what it feels like. Does she know it's coming? Can she bleed too much?

Menstruation (a period) represents a major stage of puberty in girls; it's one of the many physical signs that a girl is turning into a woman. And like a lot of the other changes associated with puberty, menstruation can be confusing for girls (and guys). Some girls can't wait to start their periods, whereas others may feel afraid or anxious. Many girls and guys don't have a complete understanding of a woman's reproductive system or what actually happens during the menstrual cycle, making the process seem even more mysterious.

Puberty and Period
When girls begin to go through puberty (usually starting between the ages of 8 and 13), their bodies and minds change in many ways. The hormones in their bodies stimulate new physical development, such as growth and breast development. About 2 to 2 1/2 years after a girl's breasts begin to develop, she usually gets her first menstrual period.

About 6 months or so before getting her first period, a girl might notice an increased amount of clear vaginal discharge. This discharge is common. There's no need for a girl to worry about discharge unless it has a strong odor or causes itchiness.

The start of periods is known as menarche (pronounced: meh-nar-kee). Menarche doesn't happen until all the parts of a girl's reproductive system have matured and are working together.

Baby girls are born with ovaries, fallopian tubes, and a uterus. The two ovaries are oval-shaped and sit on either side of the uterus (womb) in the lowest part of the abdomen called the pelvis. They contain thousands of eggs, or ova. The two fallopian tubes are long and thin - like hollow strands of spaghetti (only a little bit thicker). Each fallopian tube stretches from an ovary to the uterus, a pear-shaped organ that sits in the middle of the pelvis. The muscles in a female's uterus are powerful and are able to expand to allow the uterus to accommodate a growing fetus and then help push the baby out during labor.

As a girl matures and enters puberty, the pituitary gland releases hormones that stimulate the ovaries to produce other hormones called estrogen and progesterone. These hormones have many effects on a girl's body, including physical maturation, growth, and emotions.

About once a month, a tiny egg leaves one of the ovaries - a process called ovulation - and travels down one of the fallopian tubes toward the uterus. In the days before ovulation, the hormone estrogen stimulates the uterus to build up its lining with extra blood and tissue, making the walls of the uterus thick and cushioned. This happens to prepare the uterus for pregnancy: If the egg reaches the uterus and is fertilized by a sperm cell, it attaches to the cushiony wall of the uterus, where it slowly develops into a baby.

If the egg isn't fertilized, though - which is the case during most of a girl's monthly cycles - it doesn't attach to the wall of the uterus. When this happens, the uterus sheds the extra tissue lining. The blood, tissue, and unfertilized egg leave the uterus, going through the vagina on the way out of the body. This is a menstrual period. This cycle happens almost every month for several more decades (except, of course, when a female is pregnant) until a woman reaches menopause and no longer releases eggs from her ovaries.

How Often Does a Girl Get Her Period?
Just as some girls begin puberty earlier or later than others, the same applies to periods. Some girls may start menstruating as early as age 9 or 10, but others may not get their first period until later in their teens. The amount of time between a girl's periods is called her menstrual cycle (the cycle is counted from the start of one period to the start of the next). Some girls will find that their menstrual cycle lasts 28 days, whereas others might have a 24-day cycle, a 30-day cycle, or even a 35-day cycle.

Irregular periods are common in girls who are just beginning to menstruate. It may take the body a while to sort out all the changes going on, so a girl may have a 28-day cycle for 2 months, then miss a month or have two periods with hardly any time in between them, for example. Usually, after a number of months, the menstrual cycle will become more regular. Many women continue to have irregular periods into adulthood, though.

As a girl gets older and her periods settle down - or she gets more used to her own unique cycle - she will probably find that she can predict when her period will come.

How Long and How Much?
The amount of time that a girl has her period also can vary. Some girls have periods that last just 2 or 3 days; other girls may have periods that last 7 days or longer. The menstrual flow - meaning how much blood comes out of the vagina - can vary widely from person to person, too. Some girls have such light blood flow that they wonder if they even have their period at all.

Other girls may be concerned that they're losing too much blood. It can be a shock to see all that blood, but it's highly unlikely that a girl will lose too much: For most girls an entire period consists of anywhere from a few spoonfuls to less than 1/2 cup (118 milliliters) of blood - it just looks like a lot! (It is possible for a girl to lose an excessive amount of blood during her period, but it's not at all common. In some cases, a female will bleed too much because she has a medical condition - such as von Willebrand disease.) The amount of blood a girl loses and how long her period lasts can differ from month to month.

If you're worried about your blood flow or whether your period is normal in other ways, talk to a doctor or nurse. Some changes in menstrual periods can be normal - but only a doctor can help determine the cause of irregular, heavy, or painful periods - or no periods at all.

Cramps, PMS, and Pimples
Some girls may notice physical or emotional changes around the time of their periods. Menstrual cramps are pretty common - in fact, more than half of all women who menstruate say they have cramps during the first few days of their periods. Doctors think that cramps are caused by prostaglandins, a chemical that causes the muscles of the uterus to contract.

Depending on the person, menstrual cramps can be dull and achy or sharp and intense, and they can sometimes be felt in the back or the thighs as well as the abdomen. These cramps often become less uncomfortable and sometimes even disappear completely as a girl gets older. In the meantime, many girls and women find that taking an over-the-counter pain medication like acetaminophen or ibuprofen can provide relief from menstrual cramps. Taking a warm bath or applying a warm heating pad to your lower abdomen can sometimes help, too. Exercising regularly throughout the monthly cycle may also help lessen cramps in some people. If these things don't help, ask your doctor for advice.

Some girls and women find that they feel depressed or easily irritated during the few days or week before their periods. Others may get angry more quickly than normal or cry more than usual. Some girls crave certain foods. These types of emotional changes may be the result of premenstrual syndrome, or PMS.

PMS is related to changes in the body's hormones. As hormone levels rise and fall during a woman's menstrual cycle, they can affect the way she feels, both emotionally and physically. Some girls, in addition to feeling more intense emotions than they usually do, notice physical changes along with their periods - some feel bloated or puffy because of water retention, others notice swollen and sore breasts, and some get headaches. PMS usually goes away soon after a period begins, but it can come back month after month. Doctors recommend that girls with PMS try to exercise to help feel better. And some girls notice that restricting caffeine intake may help relieve PMS.

It's not uncommon for girls to have an acne flare-up during certain times of their cycle; again, this is due to hormones. Fortunately, the pimples associated with periods tend to become less of a problem as girls get older.

Pads, Tampons, and Liners
Once you begin menstruating, you'll need to use something to soak up the blood - either a pad or a tampon. There are so many products out there that it may take some experimenting before you find the one that works best for you. Some girls use only pads (particularly when they first start menstruating), some use only tampons, and some girls switch around - tampons during the day and pads at night, for example. Girls who are very active, particularly girls who enjoy swimming, often find that tampons are the best option during sports.

Periods shouldn't get in the way of exercising, having fun, and enjoying life. If you have questions about pads, tampons, or coping with periods, ask a parent, health teacher, school nurse, or older sister.

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