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Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole and joining me today is Dr. Julia Cron. She's the Site Chief of Obstetrics and Gynecology at New York Presbyterian, Lower Manhattan Hospital and Vice Chair in the Department of Obstetrics and Gynecology at Weill Cornell Medicine. She's here to address irregular or painful periods in our adolescents.

Dr. Cron, thank you so much for joining us today. So first of all, as our teens and adolescents get into that time of their life, you know, we all know what that's like, what are the characteristics of a normal period? And what's considered heavy or irregular. Please sort that out for us as we get into this topic today.

Julia Cron, M.D., FACOG (Guest): Thanks so much for having me here today, Melanie. I'm happy to be here and be with you to talk about one of my favorite topics, adolescent periods and the changes accompanying the transition from adolescence into young adulthood. So the question of what is a normal period is a really good question and a good framework for young women who are entering that changes of puberty to kind of know what is normal and what's not normal.

So I think the thing that I like to think about is number one, the timing of puberty and the tempo of it. In other words, like how long should it last? A lot of parents, guardians come to me, the moment they notice breast development in their young adolescent or preteen, and thinking that potentially they're going to get their period within the next couple of weeks, which is not the case, fortunately. Puberty does last a while, so it's important to kind of have a sense of how long that's going to last. And the normal tempo is that most girls will get their period about two years after they first notice breast development. So if they notice breast development at 10, it's expected that they'll get their period around 12.

Now of course not everybody reads the book, but that's a good guideline. The average age of the first period is about 12 and a half in the United States. And another thing to consider when you're thinking about pubertal changes is the sequence. So the normal sequence of puberty is first breast development, then hair growth, both underarm hair and pubic hair. Then most teens will get a growth spurt and then they will get their period. So we like to say that menarche, which is the beginning of the menstrual period, is the culmination of puberty.

So it's kind of the finale. And so that's a good thing for teens and their caregivers to know, kind of what to expect. So normal sequence, normal timing, in other words, when does it happen? And then the normal tempo, which is about two years. Once they get their periods, then you know, the question of what is normal, most menstrual cycles last between 21 and 35 days.

And that's the time in between periods. So, the other important thing is that a lot of young adolescents take a while for their periods to get quote normal. But we usually say, by the third year after menarche remember, that's the first period, about 80% of menstrual cycles are quote normal of 21 to 35 days.

So if a young woman is five years after menarche and she's still having irregular periods, that's a reason for investigation. In terms of how long periods last, they usually lasts about five to seven days. And the heaviest time is usually in the first three days. The average age is about 12 and a half in the United States.

One thing that is often asked is when do you start investigating in terms of not having a period? And we usually say if a woman hasn't had her period by 15 or 16, that's a good time to start thinking about looking for reasons for that. Also importantly is to determine whether she has had other signs of pubertal development. In other words, has she had breast development, hair development and a growth spurt, but no period, or has there been no development? And if there has been no development, then we generally say seek medical advice earlier than that.

Host: So when we're talking about painful or irregular, and you've given us great definitions of menarche, and when girls start these things and when parents really should see their doctors about this, what about painful, irregular? I know my daughter had them and she had a bit painful period and took her to her gynecologist for her first appointment. So when do parents bring them into you if these things seem a little bit off, if they're painful, if something is irregular about it?

Dr. Cron: Good question. So, I like to kind of separate painful and irregular. There's often overlap in terms of, reasons why those are happening. But in order to kind of get at the cause and possible management of it, separating painful from the irregular. So let's first talk about irregular, which to me is, saying the timing is not right. And so remember we said that a normal cycle, in other words, the time between periodsis between 21 and 35 days. So if somebody is having their period every two weeks, I would say that's not normal. And also if it's more than two months between the period, that's another reason for investigation. Now everybody can have a one-off, but in general, if it's consistent, in other words, if they are having bleeding consistently every two weeks, that's not normal. If they are consistently having their periods two to three months that's also not normal, particularly if their first period was over two to three years ago. So that's kind of the irregularness. The second thing to think about when you're thinking about irregular or abnormal periods is the heaviness of it. So again, we said the normal period lasts five to seven days with heaviest blood loss in the first three days. But in general, the amount of bleeding should not be excessive and that's sometimes hard to quantify. But asking the questions of is it soaking through your clothes? Is it soaking through your pajamas at night? Is it getting on your sheets when you're sleeping? Are you changing your tampon or pad every two to three hours? Do you notice a gushing feeling, all of those things signal potentially the period is too heavy and needs some investigation.

In terms of pain, that is somewhat subjective. It's hard to quantify, but I usually go with the is it disrupting your life? So if someone is missing school, missing activities, missing time with their friends, then that's a reason for investigation.

Host: So tell us about the new Pediatric and Adolescent Gynecology Services at Weill Cornell Medicine. What do they entail? Tell us a little bit about what you're offering.

Dr. Cron: Yeah, I'm thrilled to be talking about the Pediatric and Adolescent Gynecology Services here at Weill Cornell Medicine. So, currently we are seeing patients at our lower Manhattan site, right near lower Manhattan Hospital, on William street in lower Manhattan. And we are offering the full spectrum of pediatric and adolescent gynecology services. In terms of things that we are managing, usually in the pediatric sense and the pre pubertal sense we are taking care of, these are mostly rare conditions, young girls with ovarian cysts, dermatologic things like vulvar dermatitis or some skin conditions that can affect the gynecologic area. We also think about some infection problems and young girls, some abnormal bleeding in pre pubertal girls.

Shifting to the adolescent, we manage problems related to puberty. I like to talk about the P's. So mostly it's problems related to puberty, periods, pain, pregnancy prevention. We talk about the full scope of contraceptive options, and also preventative medicine. So what we do with adolescents is preventative medicine, talking about vaccines, talking about risk reduction. Talk about screening for sexually transmitted infections, cancer screenings, such as pap smears. I think a lot of what we do for adolescent care is about preventative medicine. The other thing that we are offering is service for gender minorities, so, we are caring for patients that are gender questioning or transgender, or, in general fit under the category of gender minorities.

Host: Dr. Cron, can you briefly give us an overview of some treatments that you might try for teens and adolescents with painful or irregular periods?

Dr. Cron: Yeah. Fortunately today we have a lot of great options. I would say for painful periods, the first thing is we usually just try pain medicine, for those that don't want further intervention. But then there's lots of great options, most notably hormonal modification. So, that comes in many different forms, including oral contraceptive pills.

I always like to say, I wish we had called it the period modulator or the hormone modulator. Because remember that oral contraceptive pills are not just for contraception. Along those lines, we have variations of oral contraceptives, such as hormone patches, rings. There's also, injectable, hormones that can help with periods.

And then there's some more long lasting things, which is really great that we can offer this to our teens. Things like the contraceptive implant again, a hormonal modification and then the hormone releasing intrauterine device or the IUD, which can last up to seven years, which is really great for our teens, particularly our teens that need management of their painful and or irregular periods and contraception. Again, talking about behavioral intervention, there's lots of behavioral things to kind of help manage these problems as well.

Host: Before we wrap up when these girls are coming to you and their families and what a breadth of services that you're offering there at Weill Cornell Medicine, I, really feel it's so needed right now. When you meet with the girls alone in a room because the mothers have to step out at some point. What is it they most want to know? If you were to speak to them right now, if you were to speak to the mothers who are sitting outside wondering what their daughters are talking about, what do they want to know from you? What advice do they seek?

Dr. Cron: That's a great question. I also, I like to add to my P category is privacy. So making sure that young women know that they have a place that's private and can ask those questions and have the ability to talk to a trusted adult. I think that's really important. So, yeah, I would say the most common question that I get is the is this normal. I think most teens in many aspects of their life want to know what they're experiencing or feeling or seeing is normal. So a lot of what I do is, validating their concerns and talking about what is normal during puberty and what are the things that are not normal and what are the things that require investigation. And I think that was a great way in terms of what we discussed in the beginning of this podcast is, recognizing what's normal, what's not, and what needs investigation.

Host: What a great podcast. This was so educational and informative. You're really a very good educator, Dr. Cron. As we wrap up, give us your best advice for helping our daughters stay healthy during menstruation years, dealing with heavy, painful ro irregular periods and how much that overall health, and especially now with the mental health crisis that we are seeing among our youth in this country, how that overall health and wellness, whether it's weight, activity, smoking, alcohol, mental health, stress; all of these things can affect our periods and the symptoms. And so many of those symptoms are non-specific. So sometimes they overlap. I'd like your best advice about keeping our girls as healthy, physically, mentally overall at that time of their exciting lives.

Dr. Cron: Your point about the importance of mental health, is really, really important. So, one thing, in terms of, advice, I would say, do not underestimate the importance of mental health. One thing that a wonderful pediatrician told me once is mental health trumps all, and I think that's really true, particularly, in today's day when we're really dealing with some very trying things and coming out of the pandemic and we can't underestimate what the pandemic did for our adolescents.

So I think making sure that mental health is in check and that patients are getting help if they need it, is really, really important. And my advice is to number one, have an army of people that can help you navigate the changes that you experience as an adolescent. And that includes peers, that includes caregivers, parents, hopefully other trusted adults like coaches, teachers, et cetera, and intervene if things are impacting your quote normal life. If you can't go to school because your periods are so bad, that's a problem. And often we can find pretty easy solutions to those problems.

And we all know what it's been like to not be in school for a long time. And we know that it has serious impact. So, young adults, teens, they need to be out there in the world experiencing the world. Hopefully we can all get them there. And get help when you need it.

Host: And you are certainly there to offer it. I imagine your kindness and passion for your profession comes through and that these young ladies really trust you and confide in you. And that's just lovely. Thank you so much, Dr. Cron for joining us today and Weill Cornell Medicine continues to see our patients in-person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download subscribe, rate, and review Kids Health Cast on Apple podcasts, Spotify and Google podcast. And for more health tips go to weillcornell.org and search podcasts. And don't forget to check out our Back To Health. So many interesting podcasts there as well. I'm Melanie Cole.

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