Hannah* was 12 1/2 when she started menstruating, and at first it seemed to her mom that things were going fine. "It was a little heavy, with what I consider to be normal pain associated with it," she says.
But with her second period, Hannah literally broke out - in terrible acne and hives. They tried several over-the-counter medications, but Hannah's symptoms got worse rather than better. Five months after Hannah's first period, they went to the doctor, who suggested trying a very low-dose birth control pill. Hannah has had one period since - and so far, her skin is fine.
Rahul Saxena, an adolescent medicine specialist at Toronto's Hospital for Sick Children, doesn't see many cases of period-induced hives, but he says other types of menstrual problems are quite common, especially excessive pain and mood changes associated with premenstrual syndrome (PMS).
Helping a young teen starts with giving her some guidance on what is normal and what isn't, he says. "There can be a lot of stress and anxiety at first."
What is normal, anyway?
Crampy pain is normal, but it shouldn't last for more than three days or be so severe that your daughter is unable to attend school or participate in normal activities. The best over-the-counter medication, says Saxena, is ibuprofen (Motrin, Advil). Give 400 milligrams three to four times a day, starting as soon as the pain starts or, even better, as soon as menstruation begins. If the pain is still severe after three cycles, a visit to the doctor is in order, and a prescription for a stronger non-steroidal anti-inflammatory drug (NSAID) may be necessary.
Minor mood changes
are normal, but don't dismiss severe alterations in mood as "just" PMS, says Saxena. "Anything that would raise alarm bells on any other day should raise alarm bells now." Extreme sadness, extreme anger or irrational thinking warrant a doctor's appointment.
Heavy or prolonged bleeding is difficult to measure, but Saxena suggests that if it seems too heavy, it's worth having a doctor check it out. The flow should lessen within three days or so, and be finished by day seven.
Acne flare-ups can be especially troublesome. "Because menstrual-cycle acne is hormonally caused, the topical treatments don't tend to have a signi-ficant impact," explains Saxena. Your doctor may suggest a low-estrogen oral contraceptive if the acne is severe, and if there are associated menstrual abnormalities. Says Saxena, "There has to be a decision about the risks (albeit very low) of oral contraceptives compared with the impact of the acne." (For more on acne see Spot Treatment.)
Empathy, says Saxena, is the most important thing that moms can offer. "This is a shared experience moms can relate to. Remember, though, that it's better to let your teen take control. Offer the help and encourage medical attention if you think it's necessary, but don't try to manage your daughter's menstrual cycle."
Saxena offers one more important point, especially relevant for teens who are reluctant to visit the doctor. "Unless there is concern that the bleeding is due to something unrelated to menstruation, there's no need for an internal exam. Your daughter should know this."
*Name changed by request.
Originally published in Today's Parent, June 2007. This content was current at the time of publication.
