A Mother's Guide to Her Daughter's Menstrual Health

"Mommy, what happens if I'm not home when I get my period?" asked my older daughter, nine years old at the time and already anxious about the prospect of menstruation.

I realized my daughter, who asked to be called "Emma" in this article, had been secretly worrying about her period. As her mom, I needed to reassure her. My own menstrual education had come from a dog-eared copy of Judy Blume's classic, Are You There God? It's Me Margaret. When I started bleeding in sixth grade, the first of my friends, the experience was bewildering and tinged with shame. I wanted to do better for my daughters.

Five years and many conversations later, I have learned the essentials of supporting my two daughters as they approach reproductive maturity. Along the way, I have updated my own knowledge and been inspired by new ways of thinking about menstruation.

(While this article uses the terms "girl" and "daughter," not all kids who menstruate identify as female, and the advice here applies to non-binary and gender-nonconforming young people as well).

Most girls start their periods between the ages of 10 and 15, and the average age for American girls is now 12.25 years old, according to a 2018 article in the Journal of Pediatric and Adolescent Gynecology. Race, ethnicity and body mass index all affect when a girl is likely to get her first period.

Given that girls of all backgrounds today are starting their periods earlier than previous generations, it's important to start talking early with your daughter.

"A girl's first period doesn't signal the start of puberty. Puberty commences silently in the brain long before menstruation begins," wrote Louise Greenspan, M.D., a pediatric endocrinologist, in her 2014 book, "The New Puberty: How to Navigate Early Development in Today's Girls."

I first discussed periods with my girls when they were in preschool, asking questions about the string between mommy's legs while we were in the bath.

To start this conversation off right, make sure your child has a good book or two on periods, and make yourself available to read together if she chooses.

I bought my girls "The Period Book: A Girl's Guide to Growing Up" by Karen Gravelle, which weaves charming illustrations with friendly straight-talk about menstruation. This book helped us navigate the awkwardness of puberty conversations, as did "The 'What's Happening to My Body?' Book for Girls," by Lynda Madaras.

Give your kids a chance to explore these books on their own, and be available for discussion. Take a pragmatic approach when answering questions, and be honest if you're feeling uncomfortable or don't know the answer.

Next, help your child be prepared for her period. You can buy (or even make, as this mom in Hawaii demonstrates) a "first period survival kit": a small pouch that contains pads, a change of underwear, tissues, and wet wipes. Discussing the materials in the kit together allows for easier conversation.

You can get creative and slip in a stick of gum or a little note. Starting in fifth grade, Emma carried around a period kit in her backpack. The presence of this handmade purse, gifted by a friend's mom, comforted both of us.

When I was Emma's age, the only choice for periods was pads or tampons, usually wrapped in pastel packaging. Today, options abound.

I bought each of my girls a starter pack of "period panties," an environmentally friendly way to absorb flow and prevent leaking. These moisture-wicking, super-absorbent underwear can be worn alone on light days or with pads or tampons on heavier days.

I also appreciate the panties' cute styles and bright colors, as well as the empowering language in their packaging. Their aesthetic tells girls that having your period is just a normal part of being female. In our house, we like panties by the teen version of Thinx, Thinx (BTWN), and KnixTeen; RubyLove is another option.

Because it's a new product, period underwear is still fairly pricey. Hopefully, as it becomes a wardrobe staple available to all people with periods, prices will fall. (We haven't tried them, but Amazon already sells some $5 period panties). Reusable panties should save you money on pads and tampons in the long run.

Both you and your daughter should know it may be hard to predict her cycle, especially at first.

"It may take up to two years for cycles to become 'regular,'" said DaCarla Albright, M.D., associate professor of Clinical Obstetrics and Gynecology at the University of Pennsylvania School of Medicine and a member of HealthyWomen's Women's Health Advisory Council.

"Most young women report cycles every 21 to 35 days, with a range of up to every 45 days, within three years after their first period," wrote Albright in an email to HealthyWomen, adding that active flow can last anywhere from two to seven days.

Given this wide variation, Albright recommends that girls track their periods through smartphone apps. Tracking cycles and associated menstrual symptoms can increase a girl's sense of control, as well as her self-assurance and understanding of her body.

I use Clue to track my own period, liking the user-friendly format that tracks cramps, breast tenderness, energy level, and other symptoms throughout the month. Emma has made her own choice, and she uses PeriodTracker, which she finds simple, clear, and organized.

Within a few months of starting their cycles, both my girls asked to use tampons. I was initially wary of this step, recalling how I struggled alone in a locked bathroom with the instructions from the Tampax box, fearing I'd lost a cardboard piece somewhere inside me. But my kids are both athletes, and they were adamant: they wanted to go swimming, play soccer, be liberated from bulky pads.

So I bought tampons with a rounded plastic applicator, which seemed the friendliest for novice users. A midwife friend recommended placing a little coconut oil on the tampon tip to ease insertion, and I waited outside the bathroom door for each girl's first attempt, available for questions and advice.

"What about toxic shock syndrome?" asked Emma, who'd heard about the potentially life-threatening disease—and its link to tampon use— in health class.

I reassured her that menstrual toxic shock syndrome is a rare if severe illness, affecting only about 3 in 100,000 menstruating women. If she used the minimum absorbency tampon needed for her flow and changed tampons every 4 to 8 hours, she would be at very low-risk. Learning these statistics seemed to ease her mind.

Insertion of the reusable menstrual cup may be difficult for adolescent girls, and since I've never used one myself, I didn't feel comfortable teaching my own daughters. However, recent research demonstrates that it is generally "a safe option.".

It's also vital to give your daughter the knowledge and skills she needs for good menstrual hygiene. This includes reviewing the basics of vaginal hygiene, like wiping from front to back after using the toilet (to avoid contaminating the vagina with bacteria from the anus) and never douching.

You might not realize it, but girls may also need guidance on how to dispose of menstrual products. I have demonstrated how to wrap up used pads and tampons with a wrapper or toilet paper before disposal, and given reminders to use the trash can.

Luckily, taking care of period panties is easy: give them a quick cold-water rinse, toss them in with the rest of the laundry, and hang to dry

While Albright emphasized the role of mothers (or caregivers) in reassuring girls that "the onset of menses is a normal transition," she also said that health-care providers are important allies in menstrual health.

First make sure your daughter is comfortable with her health care provider, especially at this age. We switched pediatricians a few years ago, at both girls' request.

Your daughter's pediatrician or family nurse practitioner can offer guidance, for example, about alleviating period symptoms such as cramps. And of course they are a resource if more serious problems arise. If you are concerned that your child's symptoms are severe enough to be debilitating, make sure you schedule a visit.

Because the menstrual cycle can cause changes in vaginal pH and increase the chances of yeast infections at certain times of the month, talk with your daughters about how to spot signs of infection, such as itching or discharge.

According to Albright, young women don't need to see a gynecologist for their first pelvic exam and pap smear screening until age 21, unless they have a menstrual disorder or another gynecological concern.

Supporting your daughter's mental and emotional health during menstruation is equally as important as the physical side.

Like adults, teens may suffer from symptoms including premenstrual syndrome (PMS). A more serious conditions is premenstrual dysphoric disorder (PMDD), which affects 3-8 percent of all women, according to William Parker, M.D., a clinical professor of obstetrics and gynecology at the UCLA School of Medicine.

My girls have both experienced moodiness and bloating, as well as other period side effects like acne and cramps that impact their self-confidence and energy level. Navigating these cyclical changes is particularly challenging for adolescents, who are already riding the emotional roller coaster of puberty and often anxious about the social demands of middle/high school.

Encourage her to rest more during her period if she needs to, slowing down and tuning in to her body. I've let my daughters stay home from school on at least one occasion during a particularly arduous period. Christiane Northrup, M.D., views the menstrual cycle as an opportunity for self-awareness and "psychological cleansing." I've always loved this reframing of PMS and period moodiness, and hope to pass this wisdom on to my girls.

I am glad that my girls are coming of age at a time when menstruation is becoming a mainstream topic. The new "menstrual movement" is focused on activism, product innovation, and policy advocacy.

In her book "Periods Gone Public: Taking a Stand for Menstrual Equity," Jennifer Weiss-Wolf advocates for "laws and policies that ensure menstrual products are safe, affordable and available for those who need them."

And PERIOD is a global organization fighting to end period poverty and stigma, founded by two 16-year-old high school students. PERIOD is now the largest youth-run NGO in women's health, and one of the fastest growing in the United States. It may be a movement your daughter wants to join.

I can't know if my own girls will remember their early periods with shame or anxiety, exasperation or indifference. But all signs show that this generation of mothers is stepping up to support our daughters. And that's progress.