Maggie McKay (Host): Welcome to Conversations Like No Other: presented by Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad, everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. I'm your host, Maggie McKay.

Today, we have with US pediatric gynecologist, Dr. Kelly Woodfield, to discuss talking with your daughter about menstruation. Thank you so much for being here.

Dr. Kelly Woodfield: Thanks, Maggie. Always happy to be here.

Host: So, this is always an awkward conversation to have with your daughter. I think, I mean, maybe not everybody feels it's awkward. But I remember growing up at school, we had this movie and the moms had to come with us so they didn't have to talk to us about it. So, I'm sure they don't do that anymore. But at what age should parents start talking to their daughters about periods before it happens?

Dr. Kelly Woodfield: Oh, okay. This is such a good question. I too had the most awkward experience learning about periods. And I think it has gotten better over time, but still it isn't easy. So, the key is to talk about periods long before they happen. The longer you talk about it, the easier it is to normalize the process. And it allows kids to gear up for, you know, this time of change.

The body's going through a lot of changes in the two to three years before the period. And so, I would say start having the conversation even before puberty starts. And I think it just takes bringing it up in normal conversations. Like, don't avoid the topic, just talk about periods and let the questions flow naturally from there. So, as early as little kids and well before puberty.

Host: What are the biggest myths or misconceptions you hear about first periods?

Dr. Kelly Woodfield: I think it depends on the kids. I feel like some kids are really excited for their period and they're disappointed when it isn't perfectly regular the way that it's been advertised to them by their moms and their sisters and their friends right off the bat. And so, the first couple of years of periods, I mean, for some people it is regular right off the bat. But for a lot of girls, it takes a good two to three years before you establish what your cycle is going to look like. And so, what I try to remind kids is that the period apps are great. You should absolutely use them to help you track your cycles.

Host: There are apps?

Dr. Kelly Woodfield: Oh my goodness, there are apps. I know, I'm still used to like the paper calendar, okay? And you really want to make sure you get like an age-appropriate app. But these apps, they do a lot. Obviously, for teens, you want just like a pretty simple app of just like, "Hey, what days are you bleeding and when is it happening? And what is your flow like?" Because if there are any problems, it's really easy to show your parents, show your doctor, because it is kind of hard to recall from memory what exactly your periods have been doing over the last year.

Anyway, so these apps, they're really good at predicting when your next period is going to be, or at least they think they're good at predicting. And so, these kids get really stressed out when their phone is like, "Hey, your period's due," and they haven't had their period, or they get their period three days late, which is actually like well within the realm of normal for their age. But the apps are geared towards adults and not for teens. And so, it's okay that your period is a little irregular. And if you have any questions about if your cycle is regular or not, just ask your pediatrician, ask your doctor, and we're more than happy to take a look at the calendar and let you know if yours is normal or not.

Host: Dr. Woodfield, I'm still back at where you said that a lot of people are excited to get their first period. I'm thinking, "What?" I have never heard of that, but it's such a different era now.

Dr. Kelly Woodfield: It is. Well, if I may, I would say like the other half, and this is the camp I definitely fell in, they're not that excited. And so, I think there's a lot of misperceptions about, you know, that it's going to be really heavy, really painful, that the whole world is going to know when they're on their period.

And so, if that's the case—I'm actually glad you brought that up—for the rest of us, most of the time periods are okay. I mean, sometimes they're pretty unpleasant and like, yeah, there's versions of periods out there that are pretty heavy or pretty crampy. But most of the time, it's all right and it takes some getting used to, but it's going to be okay. And you've got a whole community of people around you to help you.

Host: And what's considered normal when a girl gets her first period?

Dr. Kelly Woodfield: Yeah. So once again, teenage periods are notoriously a little irregular, and just because your period looks like one thing in the first few years of your life, it doesn't necessarily mean that that's what it's going to look like later in adolescence or in your 20s or 30s. So, a normal teenage period should last for seven days or less.

I mean, you should typically have more than like one or two days of bleeding. So, somewhere between like four to seven days of bleeding. It might not come perfectly every single month. But after the first year of periods where kind of anything goes in the first year, but by year two or three, periods should fall in this 21- to 45-day range, if you count from day one of bleeding to day one of bleeding of your next cycle.

Host: And how can parents normalize periods without making it a "big, scary talk"?

Dr. Kelly Woodfield: That's a good question. And I think it takes practice. I mean, one, I think you have to examine your own feelings about periods and just making sure that there's not a lot of shame. And I think that there's a lot of protection in using medical terms. Call it periods, call it menstruation, call parts of your body, the vagina, the vulva. But it kind of takes the cultural, social meaning out of it, and you can just talk matter of fact.

But I also think it's just allowing a culture or just a dialogue of curiosity and questions and laughing at how awkward it can be sometimes. And just focusing on the curiosity side of things is a good way to help normalize.

Host: Maybe don't get your information from your friends who have no idea and make it up.

Dr. Kelly Woodfield: Oh my gosh. I spend so much time in my visits correcting these things. Because, I mean, like, your community's a really important source of strength. And just like knowing what's normal, what's not. But also, there are a lot of misperceptions out there. And just because one person's period looks one way—or they reacted a certain way to like one kind of medical intervention to make a period better—doesn't mean that you're going to react that way. So yeah, that's a fantastic point.

Host: So, not every girl has a mom or an older sister. So, how would you encourage dads to discuss periods with their daughters, or even if there is a mom involved? What should they do?

Dr. Kelly Woodfield: Okay. These are actually some of my favorite visits when the girl comes with their dad in tow, because I feel like there's just a lot of teaching going on for everyone. So, I think, you know, number one, just normalize it. Even if you're embarrassed, own your embarrassment, own how much you wish you knew about this.

And I think, once again, this point of, like, approach it with curiosity. Ask your kid like, "Hey, how often are your periods coming? How can I help you? How is this going for you? What does it feel like?" Like, I wouldn't know." And just trying to dig a little into what their experience is and asking how you can be there to support them. There is no expectation that you have to have all the answers. In fact, even women who do have periods still don't have all the answers. And just because a parental figure may have a period, her period may not be exactly the same as her daughter's periods. There's always going to be a little bit of limitations there. But don't be afraid to ask for help. Don't be afraid to go to your pediatrician, to your gynecologist, and ask and just normalize it and laugh at how awkward it can be sometimes.

Host: Now, there are a lot of options, pads, tampons, period underwear. What should parents start with and why?

Dr. Kelly Woodfield: You know, it's really child-specific. I think that, in my patient population, most kids start with pads or period underwear. Period underwear does exist. It's a great thing for my youngest teens, but even like my older teens and my young adults still use period underwear.

It's really good for these younger girls who are maybe a little too embarrassed to raise their hand and go to the bathroom to change their pad because you just kind of wear it and it's designed to last for an entire day. So, theoretically, you wear one in the morning and then you change it and you wear it to bed. And as an aside, if you're needing to change your period underwear multiple times a day, the period might be a little too heavy and you should come see me. But it's a really nice way for these younger kids to not have to worry about the hassle of pads.

But I mean, pads are by far just a super easy option. They do take a little bit of getting used to in terms of the sensation of wearing a pad. And that's why I think a lot of folks default to the period underwear, but I get a lot of parents asking me like, "Well, what's the right age for kids to start wearing tampons?" And there's actually no right age. It's whenever your daughter or the kid expresses an interest in trying to wear a tampon.

I think there's some fear or anxiety about like, "Oh, but they're so young. Is it the right size?" And, yeah, if you're having a period and you're willing to try it, then that's the right time. And if you're having a hard time, come see me and I'll just make sure that everything's working okay.

Host: You mentioned the amount of bleeding. What is normal and when should you call the doctor?

Dr. Kelly Woodfield: Period bleeding is notoriously very difficult to quantify. And I think that it's an art to learn how to get a teenager or even an adult to like really tell you how much they're bleeding. But interestingly, like at the end of the day, our official guidelines say that it doesn't matter how much blood you're losing. If your patient says that it's too heavy, like they're just perceiving it to be too heavy, then it's too heavy and you should do something about it. The studies that we're able to quantify, like a typical blood loss in a period, they found that most people lose on average about two to three tablespoons. So, this usually translates to people using four or five regular-sized pads or tampons a day on their heaviest day. So, too much bleeding is if you are soaking a pad or large tampon, front to back, side to side all the way through in an hour for more than two hours. Like, that's way too heavy. Please see somebody.

It's normal to pass little clots or little clumps of blood. I would say little to me is defined as like dime-sized. But if you're passing clots that are quarter sized or larger, that's probably too heavy. You should see a doctor.

It's also normal for folks to every once in a while have bleeding that's heavy and leaks under their pants during the day or under their bed at night. But like, as you get older and start learning like what your limitations are, those accident should happen with less and less frequency. But if this is continuing to happen to you, and this is like a every period occurrence, that's also a sign that it's too heavy and you should see a doctor. Because, one, it can really affect your quality of life. But two, it puts you at risk of anemia or iron deficiency, which really can impact your functioning day to day.

Host: What period symptoms should never be ignored?

Dr. Kelly Woodfield: So, really heavy bleeding should never be ignored, because all of these things happen by degrees. And it really is hard to know what's normal and what's not, especially if you know all of these things have been happening to your sisters and to your mom.

But if you're having any kind of symptom, whether it's the amount that you're bleeding or how much pain you're in or your vomiting or you get really bad headaches or your mood is just so bad that you're not able to function, where you're consistently staying home from school, you're missing your friend's birthday party.

You're not going to go to your swim meet because you're worried about X, Y, or Z. That should never be ignored. Periods are not that fun. But they should be something that we all can learn to live with. And if you're not able to do the things that you need to and love because of your period, that should never be ignored because we definitely have ways to help you.

Host: So, what role does a mom's own period experience play in these conversations?

Dr. Kelly Woodfield: So, I've seen a lot of moms where moms have had heavy periods, crampy periods, and just back in the day, us doctors were just not that good at acknowledging this or treating it. And so, I've seen moms who've had bad or difficult periods themselves be able to recognize those same signs and symptoms in their daughter. And then really advocate for their daughter and say, "No, she shouldn't be living like this for 10 years before she gets a diagnosis. Please let's get her plugged into care." And those are really powerful.

But I also think your daughter's periods may be very, very similar to your own, but I've also seen plenty of cases where it's the complete opposite. Like, you may have had fantastic periods that were short, light, not that crampy, but your daughter really is complaining of cramps. And it can be kind of hard for moms to understand if the kid is just trying to get out of their math test or if these symptoms are real.

And so, I think there's a lot of power in your own experiences, but I think it's also making sure to have a genuine sense of curiosity about what your kid is going through, and that it could be different than your own. And I do see that that does tend to be a source of friction or conflict during some appointments for me, like when there is a vast difference in experiences there. So, be supportive, be an advocate, but also be open to the fact that, you know, there is a huge spectrum of experiences when it comes to periods for even within families.

Host: And there's always the girls who are the first to have their periods, and then the ones who are later in the year or whatever. So, how can moms support daughters who get their period earlier or later than their peers?

Dr. Kelly Woodfield: This can be challenging. Once again, there are those girls out there who are just delighted to be the first among their friends to have periods. But that was also not my experience. And I think for the most part, when you're the first kid in your friend group to have a period and you're taller than everyone else and you're wearing bigger bras and you're going through stuff, it is a lonesome place to be. And it's hard because people can't help but treat you a little bit differently. And there's like some real documented evidence out there that we tend to assume that these kids, just because they look physically mature, that they're emotionally mature, and that's just not the case.

And so, it's just love, it's encouragement, it's checking in, asking how they're feeling. And just reminding them that, yes, even though you feel like you're standing alone today, just give it a few months, give it a year or two, and everyone else is going to start looking just like you. And then, you get to be in the advantageous position because you're the expert and you can start giving all these useful tips and tricks that, you know, all of us women really rely on in the community.

If you're later than all the rest, then that's hard too. I mean, some kids are like, "Whew, I lucked out. Like, I haven't started my period yet." But other times, it is hard. And so, I would say if you're really not showing any signs of puberty or maturity by age 14, 15, go see our doctor. But short of that, sometimes it's just helping these kids be patient.

Host: And what's one empowering message every girl should hear about her period?

Dr. Kelly Woodfield: So, everyone has such different relationships with their period. Sometimes it's really positive. And sometimes it's like a lifelong negative thing. And I would say, if your period is consistently a negative monthly experience for you, it doesn't have to be. And, one, you're not alone. I think that that's one of the most beautiful things about being a woman. It's like, yeah, we do have these shared experiences with periods, but there can be a lot of support there. And don't be afraid to come to your doctor if your periods are so heavy that you can't do what you love or the cramps are bringing you to your knees. It doesn't have to be that way. Please go get help for that.

So, I don't know if that's actually the most empowering message, but just know that your natural period doesn't have to stay that way.

Host: And in closing, is there anything else you'd like to add?

Dr. Kelly Woodfield: We covered a lot. The things that I always try to advocate for is just know how much bleeding is too much bleeding. And please never go three months between periods. If you've hit that three-month mark and you haven't had a period, please go see your doctor. I think that's the only other thing I'd add.

Host: Well, thank you so much for sharing your expertise and giving us some great advice through something every woman has to navigate sooner or later.

Dr. Kelly Woodfield: It was a pleasure. Thanks for having me on. I appreciate it.

Host: Absolutely. Again, that's Dr. Kelly Woodfield. For more information about pediatric gynecology at Valley, please visit valleyhealth.com/pedsgyn. That's P-E-D-S-G-Y-N. Thanks for listening to Conversations Like No Other: presented by Valley Health System in Paramus, New Jersey. And if you'd like more information on today's topic or to be connected with today's guest, please call 201-476-0040 or email valleypodcast@valleyhealth.com.