Episode 25: The first period and how caretakers can address it

Dr.Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone, and welcome to the Dr. Sophia ObGyn podcast. Today we will be speaking on a topic that is just so interesting to me not just because I am an obgyn, but because it affects every woman's life. We are talking about periods and we'll specifically be addressing the first period. What was it like? What is it like? What is it? When should women experience it? When do girls go through it? All things period related. As usual, I am joined by my co-host and good friend Touseef Mirza.

Touseef Mirza:
Hi everyone. So, yes we are going to be talking about first periods, and it's not also just for the women who are going through or thinking about their first periods. So like teenagers or young teenagers. But it's also for the caretakers of-

Dr.Sophia:
These young women.

Touseef Mirza:
Yes, and how can we help them through this important transition in their life?

Dr.Sophia:
Absolutely.

Touseef Mirza:
So we are literally gonna go through basics and for the caretakers, for the moms, for the aunties, for the dads, for the brothers, everybody. We are gonna just be talking in very basic terms. So you can also use that to help communicate that information. So let's start with the very basics of them all, what is a period?

Dr.Sophia:
Your period is when your uterus releases the blood or the lining of the uterus sheds after it's been built up over the course of usually about a month.Your uterus is like basically waiting for a pregnancy. So it goes through these changes over the course of the month to thicken up this lining. Then when you don't actually get pregnant you then release that lining and the release of that lining is called your period.

Touseef Mirza:
So the moment that you have your period, it means that you can be pregnant?

Dr.Sophia:
That is correct. Because it means that you have had ovulation, which means the release of an egg from your ovaries, and therefore you have eggs that can be fertilized and therefore become pregnant.

Touseef Mirza:
So when we say period, it's actually when the shedding of the lining of the uterus happens and it shows up as blood.

Dr.Sophia:
Yes, it shows up as blood because that bloody tissue that was being built up now is no longer needed, so your body expels it.

Touseef Mirza:
Why is it called that? I know it's menstruation but why is it called a period?

Dr.Sophia:
It's called the period from a Greek word that kind of meant recurring cycle. I think that's how we later came to adopt it with a reg, you know, something that's happening at a regular time, in english. Now it's become basically synonymous with the word menstruation.

Touseef Mirza:
As we were thinking about this, I was trying to remember when I was young and I was 11, 12, I remember there was sex ed class and they had shown something that resembled physiologically what a woman's internal organ looked like. I had no clue what I was looking at. Like I had no clue, look like aliens or something. They said that, you know, for the woman, you're gonna have menstruation and you're gonna have the blood coming out. I was just like, I was horrified. I was like, I didn't sign up for this. Like why?

Dr.Sophia:
Why does this have to happen to me? I'm good. It's not gonna happen to me.

Touseef Mirza:
Why is this happening to me? Me and then there was this, I think I was 13. I was 13 when it happened, and I just had these cramps for a few days, but I thought I was eating spicy food or whatever. Then I went to the school's bathroom and I saw the blood on my underwear and it didn't click. Like the first thing that came to my mind, oh, something's wrong. Right? Because even if they told you that that's what would happen, you can't really understand it then I saw it and I was like, oh my God, something's wrong then I said, oh, is that what they were talking about? Is this, is this what this is? I obviously did not have any pads or anything like that, so I put some of those tissues in, but I was just very confused of what was, what was happening to me.

Then it was almost like I, me and my friend, my best friend did have a deal that the moment that it would happen to either of us, that we would say it to each other. But I just felt, I didn't know how to say it. It was very uncomfortable to come out. It was almost like my secret. Eventually, I did tell my mom because I needed something to put like a pad. I don't know if it's like that now. Hopefully people are more open when they talk about it. But it was a very sort of mysterious thing. Even if people told me about it, it just felt like I was a little bit on my own.

Dr.Sophia:
But when you say people told you about it, so you did not have a full conversation or anything like that with a close, let's say like your mom or an aunt or anyone like that to say, listen, you're now 10, 11, 12, 13, and you're now going through changes in your body and this is what we expect. So maybe this is what can happen, this is how you may feel. Or when you started having those cramps a couple of days before, did you tell anybody?

Touseef Mirza:
I probably told my mom and my mom probably gave me two Tums and called it a day. Nothing, you know, like there could be any other possibility. I'm half Pakistani, half Indian, my mom is Pakistani, and that's not something that they talk about in the house. You know, it's not something that is a very openly discussed topic. Just in general in terms of women's reproductive system, you know, or breasts or anything that is very like feminine. We don't really talk about it. So I think one of the questions that, for those that have not had their period yet might ask is, does it hurt because you associate blood with obvious pain.

Dr.Sophia:
Well, for some women they may experience some discomfort for sure. Pain, cramps, bloating, there's so many different feelings, but the actual blood itself doesn't necessarily hurt. Some women don't experience any symptoms of discomfort, cramps, or pain with getting there, period. I think there's a lot of reasons why a woman may or may not experience discomfort or the cramps or pain itself. I would say in general, most women do feel something and typically it is cramping bloatedness perhaps that can last for a few days and is, I wanna say tolerated meaning that the majority of women probably don't need to do anything about it. They definitely feel weird in their bodies, but it passes and if they do need to do anything about it, it's not anything very critical. Some women can just use warm baths or warm compresses, a water bottle that to kind of keep in their lower abdomen when they're feeling crampy.

Maybe a little bit of a belly massage or rub just to keep it on the lighter side. Some women may use painkillers such as Tylenol or Advil or something in that realm for a day or two. Some women use absolutely nothing at all. Some women, they may exercise, they may drink tea, there's so many different ways in which women manage some of the cramping pain or discomfort that they feel when their period comes. But when we're talking about the first period, I think, let's go back for a second and just relay what's happening. That first period usually comes somewhere on average.

Their age is about 12, but a period can be as early as age nine and usually as late as age 16 happens after they've had breast development typically after they've had a growth spurt, meaning they first develop these, their breast buds, then they gain some height, and then usually one or two years after that they can expect to get their first period before that first period actually happens, young girls can experience all of a sudden they start to have some vaginal discharge that they've never had before. So they see a little bit of secretions in their underwear. So that may be the very first thing that they may tell their parents about.

Touseef Mirza:
About how much time before their periods that vaginal discharge can appear. Like is it a few days or a few months?

Dr.Sophia:
Think it varies, but I would definitely say up to several months before. That's like your first signal that your uterus is now kind of activated from the new hormones that are now being released. When you're going through puberty, that's because now your body is reacting to hormones and there's a perhaps a cyclical flow of those hormones, kind of, which is what develops breast buds, which is what start to create changes in their body and their way, their body is shaped and you know, also giving them that growth spurt. So all of those things are related to hormones and pubic hair. I don't wanna leave that out, but yes. So all of these changes are happening and that includes, and I guess that's like the final thing actually is kind of like the period that happens, the last hurrah, the last part of that puberty kind of phase is when they experienced that first period.

Touseef Mirza:
So do you have any recommendations of when the caretakers could start having a conversation about menstruation with their daughters?

Dr.Sophia:
I honestly don't think that there's any special time. I think the earlier you start having the conversation, especially if it's another woman in the household, I think it's okay moreover, not just that it's okay, I think it should be encouraged for young women to see their moms, go through their periods and talk about it. They may end up in the bathroom and see their mom go and grab a pad then maybe that's an opportunity to have a conversation. I definitely think that we should be talking to our girls once they may develop pubic hair, breast buds, and acne.

Touseef Mirza:
When you say breast buds, what does that mean exactly?

Dr.Sophia:
It's the start of breast development. It starts as little nodules or buds. It feels like a little lump just underneath the skin. So it's just literally breast development, literally the very beginning of breast development. It can honestly be very painful even when those breast buds kind of erupt. You start the development of the breast tissue and that's in response to the body responding to the hormone changes that are happening. I think that that's a great opportunity to start to talk about all of the changes that will be happening because it's not just breasts. It's not just pubic hair. Certainly their bodies will grow, their physique will change, they will start to develop hips and become taller, and of course they will get their menstruation.

Touseef Mirza:
So once they're seeing their daughters starting to develop in that way, do you have any suggestions on what would be a way to start talking about it to their daughters? I don't know. Maybe it's something that some parents don't know how to approach.

Dr.Sophia:
I definitely think that parents don't necessarily know how to approach this. I know in my own experience with my own first period, I remember quite distinctly before my period actually happened, my dad actually being the person who said, oh, let's go for a ride that ride turned into, well, Sophia, I wanna talk to you about how your body's going to change I was, I was like, what's happening? Why are you having this conversation with me?

Touseef Mirza:
Yeah, because it feels like it's coming out of left field.

Dr.Sophia:
I was like, what are you talking about? Why are you talking to me about this?

Touseef Mirza:
Yeah. Did I do something wrong?

Dr.Sophia:
Like, am I in trouble? But he, oh, poor guy. He was really being sincere and trying to be like an advocate, I guess at the time, or be very progressive in talking to his daughter about the changes that are gonna happen in her body. Granted, I say that with a grain of salt, though. My dad was probably not thinking of himself as being progressive. He was trying to say, and so therefore didn't talk to any boys.

Touseef Mirza:
That was where I wanted to land this thing.

Dr.Sophia:
But I mean, he did do it in a very kind way, but it didn't change the fact that I still felt very strange. I would say, for me, luckily I lived in a household with some older female cousins whom I remembered every time I'd go to the bathroom and I'd see all this like rolled up newspaper and, you know, periodically I'd see all this rolled up newspaper in the trash and I'm like, the heck is this thing?

Touseef Mirza:
Yeah. How did that get into the trash?

Dr.Sophia:
How did-yeah. Like what's up with the rolled up newspaper and really what the rolled up newspaper was them rolling up their pads so that was the way in which in our household, we kept it quote unquote discreet I would say that the real key here in how do we first approach it with young girls, I do think that, for me it, my first conversation around it was with my dad and I must have been, I don't know, maybe eight or nine.

Touseef Mirza:
Oh, that's young.

Dr.Sophia:
Yeah. Like I said, I think it may have happened when my mom maybe told him that I, she bought me my first bra or something like that. It's funny because I don't necessarily quite remember having that full on conversation with my mom. I'm sure she had a conversation with me. But I distinctly remember going for the ride and having the conversation with my dad. I would say that it is a conversation that should start as early as possible. I think 7, 8, 9 years old is very reasonable because it has to start with just, your body is gonna change. It doesn't necessarily have to go Oh my God, you're gonna get your period it certainly shouldn't even sound like that. Oh my God. It should just be like, well, you're seven and you're growing up and I love the way that you're growing and you're getting taller, and every year your body's gonna go through some changes and we'll go through those changes together.

Touseef Mirza:
I mean, also when I remember when I was a kid, I always wanted to grow and be taller. So in that sense, it's like a nice way to say that, oh, you know, I'm gonna get taller. I'm gonna get older.

Dr.Sophia:
What is it gonna be like when I get to be like a woman? I think the first period we really have to do a good job of celebrating women, celebrating our young girls, when they go through the transition of going through puberty and going through that first period, I think it helps to decrease the level of like, shame that can be associated with it, or the concept of secrecy, or has to be my own little, it's just so private that they feel like they can't discuss what's happening with them because that actually then becomes a pervasive problem that can happen throughout their lives that they don't know how to talk to people about what's going on with them when I say people, that means even coming to medical providers or doctors, right?

So the first line would be talking to their parents or caretakers in terms of, I have a period I missed, or it's coming more often than I expect. Or it's very heavy, or it's very painful if we shame the experience or make it so that we don't allow them to have a space to talk about it, then we never know what some of the problems are sometimes the first time that we know that there's a problem with your hormones, for example, can show up as a problem or a change in your period. When we think about the first period, though, the first couple of years after you get your first period, it can be very irregular. It can come every month, it could come every two, or three months. It could come light, or it can come a little heavy.
It can be associated with cramps, it can not have cramps.

You can have nausea, headaches, bloating, all of the things that we typically would associate with PMS that makes it a little bit, kind of a little nerve wracking even so that's another reason why it's an important for us to have a really open and honest conversation that open and honest conversation needs to come from a lens or from a place of your body is going through this process. Let's go through it together. Your body is going through this process. Let me help you understand what's happening. Your body is going through this process. Let me help you feel better through this process I do think that that will make our young girls feel encouraged, not just to talk about what's going on with them, but also to feel in com comradery and community with their friends and allow them to get accurate good information especially in this day and age where everything is available to them on their fingertips, right?

They're just gonna go to whatever their favorite social media platform is to get the information. If we are not the ones who are providing it and giving them a safe space to talk about it, then it's going to be harder.

Touseef Mirza:
In order to help these young teenagers, these young daughters with their first period, is there a way that you would recommend on how a caretaker would talk to them? How would they describe what a period is? Because I think that's part of the sensitivity is that it feels maybe a little bit uncomfortable or they don't have the right know-how of saying it in a simple way. Because it can get-

Dr.Sophia:
It can get really hairy right, icky. Like, what are we saying? What are we talking about here? I think we need to bring all of the tools. I agree with you, it can feel very weird, uncomfortable from caregivers who really have no clue. I think it's important that they may be involved with their medical provider, the pediatrician and, and that kind of thing. If they really have absolutely no clue, they can start with things like books and visuals. Or even, like I said, if it's a woman, then sometimes it's easier to say mommy or sister or auntie, we have something that we will share and have in common. We will go through this process and this is what it's called, it's called your period during that time of our periods, our bodies are doing something very important.

Dr.Sophia:
Our bodies are going through a process that really is what makes us a woman. That process happens at something called our uterus. So we should use proper terms our uterus is a special place of our bodies where when we are ready to become mothers, this is the part of our body that gets pregnant the explanation of of being pregnant, even that the uterus is the place that where our womb creates this space that can hold a pregnancy every month that we don't have a pregnancy, that lining that was building up to hold the pregnancy doesn't happen then our bodies naturally gets rid of it naturally.

Touseef Mirza:
Because it's not needed

Dr.Sophia:
Because we don't need it. It naturally goes away. That natural process is called our period, in our period, that's when that blood, that nutrient rich, like the place that was going to feed it, it's a feeding place when all those good nutrients are no longer needed, it comes out of our bodies that's what comes out as our period blood.

Touseef Mirza:
So if you're telling that to me, I would have two questions as a 15-year-old, the first would be can I have a baby? Then now, now we're going a whole other ball game with the birds and the bees.

Dr.Sophia:
That's so true.

Touseef Mirza:
Because now we've opened up Pandora's box.

Dr.Sophia:
That's very, very true.

Touseef Mirza:
So that's one question, the other question would be what? Am I gonna die? Is it gonna hurt? I don't like blood. You know, like, because whenever we are taught, even as kids, like if you have a cut, like mama's gonna run to you, daddy is gonna run to you and it's gonna be, oh, no, no, no, it's gonna be fine. So we have this association and rightfully so. I mean, we're not supposed to see blood on our bodies, but I think that there's that association of something bad that has happened.

Dr.Sophia:
This is where the most important and critical point is to express that nothing bad has happened. If anything, this is what makes you a woman. This is what's very special about you being who you are and having the capability to become a mother. So the concept of pregnancy, ovulation, ovaries expressing all of the different body parts that are now developing and why it's in that development that we now have something called our period. It's very important that they understand those processes and in order to make it feel more like, wow, my body is going through this. What your body will then be capable of. It doesn't mean that she has to get pregnant by all means. However, your body has the ability to, and no, it doesn't mean that something is wrong with you. It means that your body is going through a normal and natural process.

Also to discuss the fact that yes, let us know that it's happening so that we can support you through it. It's not something that just because it's natural and normal doesn't make it easy per se. So we have to describe the discomfort and the cramps and the nausea that can happen and the headaches that can happen and the bloating that can happen and the fatigue that can happen. The fact that you may not wanna talk to your friends when it's happening, or you may not wanna talk to your siblings when it's happening or you just feel different.

You may feel a little bit sad and you don't know why. Or you just don't wanna do anything like play sports, or ride your bike. You may wanna sleep more so it's to even have the conversation so that you can make a space in the home that allows everybody to know that, you know, this little girl is going through this particular time and let's kind of give her her space, give her what she needs. You know, and just be more loving.

Touseef Mirza:
Also, I think just to check in with them because like you were saying, especially the first few periods or the first year even, there's a lot of fluctuation. It could actually be even more intense. It can be and can stabilize afterward.

Dr.Sophia:
That is correct. It does, it takes certainly several periods for it to stabilize because the whole system is kind of trying to become mature. It's the first signal that's going from the brain that then has to go to the uterus and it's coming from the ovaries so that kind of like hypothalamus part of the brain that communicates with the pituitary part of the brain that then has to communicate with the ovaries that then acts on the uterus. Through hormones that process takes a while before it can become on a regular cycle and all the pathways are in line with the timing and the cyclical nature of it. So all of that, it takes time for it to really mature just like every other part of your body. It's not overnight there are other things that just influence it. How you eat, how you exercise, what kind of stress you're under.

Touseef Mirza:
At what point do you feel that a caretaker might say we need to go see the obgyn or the physician if, because we're saying that it's normal, that it might be a little bit more intense in the first few times, first few months. But is there some, is there a point where we feel that we need more medical attention?

Dr.Sophia:
Certainly, you may need more medical attention if the blood flow is so much so that the child is becoming, like, showing signs of things like anemia, becoming very pale, very weak, dizzy, even shortness of breath going through several pads in a day. On average, we say that people go to maybe four to six pads in a day, but let's say they're going through 10, 20 pads in a day that are soaked. A normal period only goes through like a half a cup of blood a period.

Touseef Mirza:
A whole period. I've never heard that before. That's actually really important because it's true. We don't know, we don't talk about what this flow, what is a heavy flow that needs medical attention actually means.

Dr.Sophia:
Yes. It doesn't need to be an obgyn, your pediatrician is very well equipped with dealing with girls' heavy periods and able to check for other medical conditions that may be putting a young girl at risk for having heavy periods and, and that kind of thing. But yeah, it should be a process in the, definitely in those first few years where the caregiver and the girl communicate in a good way around their period that the young girl doesn't have to feel ashamed, afraid or like that it's something that she cannot say that I'm on my period. So that way she can get the kind of support that she may need during that time that support could just be, I just don't want to talk to anybody today. That support could be, my stomach really hurts, can I get something for it?. That support can be, I have a headache and that support could be, can I have a hug?

Touseef Mirza:
I think it's really important to open up that conversation when a girl is young because, or else we perpetuate the aspect of secrecy of periods for a long time into adulthood.

Dr.Sophia:
Yes, we do.

Touseef Mirza:
So to be able to write from the get-go, just say, okay, this is a normal part of who I'm gonna be that's just, you know, it's like if I hurt my elbow, I'll talk about it or you know, a natural aspect that's happening in my life, but it doesn't have to be like secret it doesn't have to be something that's wrong, it's just part of life.

Dr.Sophia:
Periods are a very big part of life. It's a part of why life continues. So if we are not keeping up with making it so it's easy for us to talk about, you know, we need to have our young girls and young women have a clearer and more comfortable understanding of their bodies, that gives them the opportunity to not have any shame around their bodies. It's another place for us to kind of put that feeling of I am a girl, I am a woman, and my body is, is beautiful and all aspects of it, and all the transitions that I go through and, and really being accepting of who they are I think that that's a very first step is when they're going through puberty to kind of embrace exactly who they are.

Touseef Mirza:
Yeah. That way is actually a great way to start normalizing it even empowering women from the get-go,

Dr.Sophia:
From the get go, from the very get go. We should be celebrating periods. It's funny how we have so many different cultural differences and examples of how women experience their periods. But one that recently came to me was the fact of the concept of the quinceanera and a lot of Latin cultures and where it's like this celebration of the transition into womanhood, which often aligns. It's the quinceanera or when they turn 15, probably aligned kind of with when they may have gotten their first periods or, you know, sometime after. But it's that celebration of the fact that you have now become a woman in the community, and your family, people are typically very happy. It's a very big celebration. It almost, and sometimes looks even like a wedding in terms of how much they are just celebrated I think that it's with that kind of encouragement and support and, and, and openness and openness and, and happiness and joy, that we should really come to every girl like that of course, every day is not gonna be your quinceanera. Every period is not gonna come as your quinceanera. But if the first one is like that, then it kind of sets up the concept. Wow, this me becoming a woman, me going through this transition is beautiful. It's special, it's mine.

Touseef Mirza:
We hold so much power in helping that happen for the next generation.

Dr.Sophia:
So we should do it. We hold so much power in our womanness, in our womanhood. Yes, our transition into womanhood with our periods. Until next time, embrace your body. Embrace yourself. Thank you for listening to the Dr. Sophia Obgyn podcast. Bye bye.

This is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.