How to talk about periods?

JOANNA MCCOSKER

Joanna McCosker is Haemophilia Nurse Practitioner at Queensland Children’s Hospital
 

Prepare your daughter before menarche

 
A girl’s first period is known as menarche.
 
Why is it important to see your health professional before your daughter’s period starts?
 
It is important to prepare and equip your daughter with the knowledge and tools to manage her period.
 
Doing the groundwork BEFORE her period starts.
 

Firstly, it's important for your daughter, yourself and your health professional to build a relationship. You want to feel comfortable and have fun so it's not too embarrassing. It is also important to set an attitude early that periods are not taboo, and you don't have to be fearful of your period starting. Young girls need knowledge, so don't fear talking to your daughter: periods are a normal bodily function for all women.
 
In the first clinic visit we want to discuss what to expect and provide a perspective of what is normal versus what is heavy and abnormal. If you come from a family of heavy bleeders and your bleeding is also heavy, you will just think that your bleeding is normal.  
 

COMMUNICATING ABOUT PERIODS

 
Communication is important and we all need to be talking the same language as PERCEPTION matters and everyone will have a different idea or understanding. We need to explain and define all the terms we use, such as a blood clot and what is heavy blood loss compared to relative ‘normal’ blood loss. The words we use to describe menstrual flow and symptoms – including both slang and medical words – need clarification and we also need to think about culturally appropriate words. What words do you use to describe your period?  Does your health care professional know what you’re talking about – do you understand them? 
 
Practically we need show the girls the ’tools’ we will use, such as pads and tampons, including the many and varied types and their levels of absorbency. This discussion should also now include the new revolution of period underwear that has become mainstream. It is essential to describe and show ‘spotting’ looks like versus a relative normal amount of blood loss compared to a soaked and saturated pad or tampon. What on earth does your healthcare professional mean when she/he says do you flood, or do you pass clots? Furthermore, is pain normal, what about cramping? What medications can be used?  When should you talk with your doctor/general practitioner/Haemophilia Treatment Centre?
 
We need to empower our young women by learning together and explaining these types of terms to our young girls before they start their period. There are many resources available to assist our young women to learn but it is most important to be matter of fact and honest. We also need to encourage them to track their periods in whatever manner they wish. Managing your period is like any other bleeding symptom that you need to report and that may need intervention!!!
 

AFTER MENARCHE

 
When your daughter has started her periods, it is helpful for her to be prepared for her clinic review. She should gather and document information including:
 

• Tracking her periods, menstrual flow (heavy, moderate, light)
• How long her menstrual cycle last for, what type of sanitary products she uses and what level of absorbency. 
• The frequency of changes – spotting, soaked/saturated, leaks, flooding overnight.
• Pain and what medications she may take and whether they are effective or do they have side effects.
• She should also consider the emotional and physical impact her periods are having on her life including work, school and sport.

 
Encourage her to make notes and have questions ready for her health care professional.
 
Please remember it is not complaining – it is symptom reporting just like any other bleeding issue.
 

PERIODS – WHAT’S NORMAL?

 
Period pain is considered ‘normal’ if:
 

• The pain is manageable or goes away if you take simple period pain medication
• It is only there for a few days before and on the first one or two days of your period
• It goes away if you use the contraceptive pill (particularly if you use the pill continuously and skip your periods
• You are able to do all of your normal daily activities such as going to school or work, or playing sport.

 
If your period pain does not fit the description of ‘normal’ and is so bad that it stops you doing what you would normally do on a daily basis, such as going to school or work, it is important to talk to your health care professional or gynaecologist.
 
Heavy periods
 
Heavy periods are also called ‘heavy menstrual bleeding’. Health care professionals may also use the terms ‘abnormal uterine bleeding’ or ‘menorrhagia’. It can be difficult to define what heavy periods are because what different girls and women call ‘heavy’ can vary. It partly depends on what you or your family are used to, and how much your period interferes with your everyday life.
 
Here are some signs that suggest that a period is ‘heavier’ than average.
 

• Soaking through a super tampon or pad every two hours or less, or needing to change protection or put a towel under you or flooding the bed during the night
• Periods that last for longer than 8 days
• Bleeding with clots bigger than a 50 cent piece
• Cramping and pain in the lower abdomen (tummy)
• Constant tiredness.

 
Source: Women’s bleeding explained in Female Factors: information for young women with bleeding disorders (Melbourne: HFA, 2018)

LOOKING FOR IDEAS ON PERIOD DIARIES?

 
Talk to your Haemophilia Treatment Centre about pictorial charts and smartphone apps that you can use to record menstrual cycles. Some have been designed specifically for girls and women with bleeding disorders.
 
There is also more information about period diaries on the HFA Factored In youth website under GIRLS