Periods really are a sign of our health. If your body is making a period happen every month, that's actually a really good sign that your body's able to do the hormonal processes that it needs to do. And that means that that's healthy. So I think a lot of people feel a lot of shame and anxiety around the idea of a period, or that they're dirty when they're bleeding. This is just a normal, natural process. For many young people.
The idea of starting to get a period is at least a little bit stressful. Doctor Katie O'Brien, a pediatric and adolescent gynecology just in the UW Department of Obstetrics and Gynecology, helps kids and families in her clinic feel more prepared for periods. She joined this episode of the Women's Health cast to talk about what periods are, how to choose the right period, products for you, when to get help for heavy or painful periods, and more.
From the University of Wisconsin School of Medicine and Public Health, Department of Obstetrics and Gynecology. I'm Jacki Haskins, and you're listening to the Women's Health cast. I am very excited to welcome Doctor Katie O'Brien to the women's Health cast today. Doctor O'Brien is a pediatric and adolescent gynecologist in the UW department of ob gyn. Thank you so much for joining me. Thanks so much for having me. I am so curious. What does a pediatric and adolescent gynecologist do?
Can you tell me a little bit about your day job? Yeah, that's a question I get a lot. There is a lot of overlap with what a general ob gyn does, but then I do have specialized training to deal with concerns specific to kids that might be more rare, like congenital concerns, like differences in how somebody was born. Or it could just be like concerns with the vulva of a little kid that pediatricians and maybe adult ObGyn don't feel as comfortable with.
So most of my job is in the clinic, but I do also work as a general ob gyn. So I do some surgeries, I deliver babies, and then I have a full clinic where I support pediatric and adolescent gynecology patients. What kind of drew you to this, subspecialty? I knew that I wanted to take care of some kind of vulnerable population. I feel like I thrive talking to people in really awkward situations. And there's not much more awkward than talking about your vagina or your period when you're a teenager.
So I really like the ability to make people feel comfortable talking about their bodies, and kind of beginning to have some autonomy over their health. What are some of the most common issues that younger patients might come to you with? Yeah, so I see patients from the time of birth into adulthood, for younger kids and babies are tends to be more issues with the vulva, things like labial adhesions or vulva or vaginal concerns. For middle like childhood kids.
Sometimes I'll start to see people with puberty concerns. Either puberty that's too early or too late. I will start to see patients who have congenital differences like we talked about. That might be a difference in how their uterus was formed or vagina or their hymen. And then I see lots of period related questions, especially for teenagers. Periods that are heavy, painful, not coming frequently enough. Stop coming. So lots of period concerns.
We are here today pretty much to exclusively talk about period concerns. I was really excited, to get an opportunity to kind of talk with you about almost like the 101 of menstruation. And I think maybe I'll start with an I've just used the word menstruation. What is that? What am I talking about when I say this word? Yeah, that's honestly a word that I don't use that much with patients. Most people refer to it as periods, and I could get funny looks when I say menstruation.
But periods are something that happens about once a month that is related to the process of preparing a uterus to become pregnant. So when kids go through puberty, their ovaries start to make hormones like estrogen and progesterone that cause the inside lining of the uterus, called the endometrial, to grow over the course of a few weeks. If that person doesn't get pregnant, then a hormonal, drop causes that lining inside the uterus to shed.
So the period blood is actually the endometrium lining and bleeding from that month. Around what age does this process start to start? I guess for younger people. Periods happen in a pretty predictable time. In the process of puberty. So puberty is what we call the process. When a child starts to develop secondary sex characteristics related to the production of hormones from their gonads, which we would call the ovaries and people assigned female at birth.
That usually starts around age ten, that puberty process on average, and it usually shows up with breast development first. So I see a lot of anxious, mostly moms wondering when periods are going to start. And I it seems like more of a mystery than it is because it's usually pretty predictable that periods will start about two years after breast development starts.
Are there other sorts of, changes that people might notice during puberty that could kind of give them the heads up that periods might be coming around the corner? Yeah, definitely. So in addition to that, breast development, which starts first, people start to get pubic hair or hair under their armpits. Most people will have a noticeable spurt. And then about six months to a year before a period start. Some girls tend to notice vaginal discharge starting.
I very distinctly remember, in the like, human growth and development classes that I had as, I don't know, fourth or fifth grader or so learning about what a period was and just thinking, I won't be doing that. Thank you very much. Feeling so nervous and, like, intimidated about this new change that seemed kind of scary to me. How how can we help prepare? How do you help prepare young people and families who come into your clinic feel less intimidated by this?
Like new life change that's probably coming, even if you really, really want to opt out. One thing that's interesting is that if you are in the fifth grade when you had that class, I bet a few of your classmates already had their periods, so they didn't even get to have that talk first. I usually recommend considering talking about it around age 7 or 8.
That tends to be the age when people are developmentally ready to at least talk the basics of what a period might be, especially because some people are getting periods at eight, nine, or ten. So that way it's not as big of a surprise. I think one way to go about it around that age is to talk anatomy talk. You have this organ in your body called the uterus. The uterus is the place that when a person gets pregnant, gets pregnant, the baby grows.
And as part of that process, people have something called periods. I think demystifying it and explaining that, yes, you have bleeding. The bleeding is not the same as an injury that causes you pain. And this is just a natural, healthy thing that our body does once a month.
I feel like there are also so many myths and weird questions and sort of there was a lot of information around, and I didn't know how to parse what's real and what's not, and what's being made to seem more scary than it's really going to be. And like, what are some of the most common myths or questions about periods that you get that you have to spend a little time, like breaking down with, with kids and families?
Yeah, I think the most common one is that periods are dirty or gross or bad, and that there's something shameful to talk about. Periods really are a sign of our health. If your body is making a period happen every month, that's actually a really good sign that your body's able to do the hormonal processes that it needs to do. And that means that that's healthy. So I think a lot of people feel a lot of shame and anxiety around the idea of a period, or that they're dirty when they're bleeding.
This is just a normal, natural process. Some other myths. The biggest one that I probably talk about is using tampons. A lot of people have anxiety about people who just started having their period using tampons right away, that they're somehow kind of damaged.
Usually they're worried about the hymen or that they're not, like, physically ready to use a tampon by the time period start, bodies are ready to put a tampon in, and that's not not going to cause anything harmful or shameful that would happen to your anatomy. I would love to talk more about, menstrual products, period. Products. Yeah, there's such a variety available.
And I also think, like, if your body might be ready for a tampon and it's kind of a new experience to have to use a product like that. So let's talk a little bit maybe about the range of options that are available. The field is totally different from even when I was learning about it, redacted a number of years ago. So what kinds of products do people have to choose from right now?
Yeah, I think that is an awesome development recently, but there are many more products on the market, especially things that are really accessible to teenagers when things seem scary. Most people start out with pads. There are lots of different sizes and shapes and thick necks. Some have wings, some don't.
We already talked about tampons, but they come in different widths and sizes, have different applicators and different absorbency, as teenagers tend to do better if they start off using something more narrow. Maybe with a tapered applicator. There are menstrual cups on the market that often is pretty intimidating for teenagers to think about, because that involves being a little bit more invasive. But I think the best invention is period underwear and period swimwear, which is newer.
So period underwear. The first brand, I think, was Pink's, and that has really exploded in the market. You can even get them in target at this point. They make them in different sizes, shapes, colors, absorbent tees. Some people like to use period underwear as sort of a security measure so that if you're using pads or tampons and you're worried about leaking, you can wear period underwear at the same time and have extra protection. I think a little more detail too, about some of the products.
So a pad is like, absorbent, product that just kind of sticks into underpants is fully external. So I think you did mention but tampons are usually also like an absorbent fiber that's inserted into the vagina. So that's an extra to the lover that's going to start over. That suddenly getting really weird judgment. So, Tampons, then, are also absorbent material that's inserted into the vagina. So it's an internal use, both of those things disposable.
So you use one when it's time to switch out or when it's full, just kind of gets tucked up, thrown away, fully disposable. And then period. Underwear and menstrual cups both fall into a reusable category. So period underwear also something fully external. You just wear them. And then menstrual cups are also inserted into the vagina. But I thought it was just worth pointing out that some of the there's a range of choices as well.
If you want a product that you can reuse, many times you've got some options in there as well as things that are, immediately disposable. Yeah, there is also the option of getting reusable pads. They make ones that are able to be like snapped into underwear that are able to be washed and reused as well.
When folks come to you, if they have come to you with questions about, choosing menstrual products, how do you help them kind of navigate what might be a good fit for them, or what might work best with, like, their lifestyle or their preferences? I do a fair amount of anticipatory guidance when people are preparing for their first period. One thing I recommend people do is consider making like a period pack for their backpack that can sometimes be in like a cute makeup bag.
So it's not really obviously something that has menstrual products in it. But things that could include are like pads, panty liners of a few different sizes, a change of underwear, maybe some ibuprofen. If your school lets you carry that. So that's one way to prepare. It can take a little bit of trial and error to figure out exactly what the right menstrual product is for you. Every person's length of period, flow of period and anatomy is different.
So they make pads and kind of different shapes and sizes and lengths. So sometimes it does take a little bit of trial and error to figure out what pad or menstrual product is large enough that it accommodates what you need it to, but still is comfortable. So you mentioned including maybe ibuprofen in, period kit to have on your person and be ready for it. And that made me think about the discomfort aspect of having periods. And that was something I remember being very scared about.
Like, I'm going to be in so much pain all the time. How am I going to manage this? So how what kinds of sensations or discomfort seem to be somewhat typical? And then also how much pain is too much pain beyond what you would consider sort of typical, tolerable, and into the point where you might want to ask your doctor for some help.
So it is common, but not always a given, that people will have some discomfort with periods that might be related to discomfort in the uterus in the surrounding area, but it can also mean discomfort. Sometimes people get things like headaches with hormonal changes. Sometimes people get breast tenderness. Sometimes people have bowel changes related to their periods and can have like cramping or diarrhea before their period starts. Most people have some amount of uterine cramping.
That's usually like a deep ache, discomfort, low down in somebody's pelvis that comes and goes, usually on the heaviest days of some of these period or right before the period starts.
If that pain is able to be managed with anti-inflammatory medications like ibuprofen or naproxen, and people are able to go and do their normal activities of daily living, go to school, do their activities and play their sports, then that's a pretty normal amount of discomfort when teenagers are getting to the point where they're in so much pain that they're regularly taking medication around the clock, trying things like heating pads and regularly missing school or sports,
that is more pain than I would expect you to have. And I would want you to see a doctor. What are some of the do we know, I guess? Do we know the causes of that sort of more than expected pain? Yeah. I think more light is being shed. On to the fact that endometrium says does develop for kids in their teenage years. And endometriosis takes an average of seven years for somebody to get a diagnosis.
What that is, is when that inside lining of endometrial cells that grow inside the uterus end up places that they're not supposed to be, usually inside the pelvis, like on the ovaries or next to the uterus. And that can cause a lot of pain every month when people have their period. But the majority of people who have significant discomfort with their periods just seem to be more sensitive to the release of inflammatory mediators that happen when somebody is on their period.
But because we can have endometriosis as a causing factor for that kind of pain, we want to make sure that we're not missing it. Kind of related to, you know, how much discomfort is too much discomfort? How much bleeding is too much bleeding? What does. I've never felt like I've gotten a truly understandable definition
of what a heavy period is. And yeah, how can how does someone know if the amount that they're bleeding within their period is also typical and expected, or if it's worth getting a little bit of like a checkup or some help for? Yeah, we have our medical, definitions of this, but I think that that is kind of hard for people to digest. So the average person loses a few tables, spoons of blood during their entire period.
But it's hard to measure things when you're looking at a pad or a tampon or your menstrual underwear. So one rule of thumb is that if your periods are lasting longer than seven days, then we would consider that to be heavy and prolonged.
If you are soaking through a pad or a tampon every 1 to 2 hours for a day or two of your period, or if you're passing large clots with your period or having accidents frequently where you're like bleeding onto the sheets at night, bleeding onto your clothes, and having accidents at school. If someone does come into your clinic with either, you know, concerns about the pain they're experiencing or concerns about heavy bleeding. What kinds of options are available for them?
So after doing a pretty thorough, history about some of these pain or some of these bleeding, I usually get a sense of whether people are interested in starting a medication to help with that. We have medications like listed, which can decrease the amount of bleeding. You can actually use ibuprofen regularly on a schedule, which can decrease the amount of volume of bleeding and can help with pain.
But for a lot of people who have significant, heavy or painful periods, that ends up meaning a hormonal medication like a birth control pill. How do those medications, work to reduce bleeding or reduce pain? So you can use them in different ways? We can use hormones in a way that brings on a scheduled monthly period that should be ideally shorter and lighter and less heavy and less painful. Or we can use medications to try to skip periods so that you have fewer periods or no periods.
And that is related to us giving you, dose of hormones, usually estrogen and progesterone, sometimes progesterone alone, that keeps the lining of the uterus thin and stable over time. This reminds me of a myth, as I was sort of digging around on social media and, refreshing myself about some of the. Yeah, period administration myths that I remember, like learning about when I was younger, was that it was not safe to skip a period.
However, it sounds like that actually is, an option that some people can have. That is a great distinction to make and something that I end up talking to patients about a lot. It is not natural to not have periods. So if you came to see me in my clinic and you told me that your periods had stopped, or that you were going long stretches and skipping periods, then I would be concerned that there was something medical going on making that happen.
That's very different from us using medications to make it so that you don't have bleeding. That happens when you're using something like a birth control pill or a patch or the ring. When we're giving you that monthly seven day break from that medicine, that brings on a period, it's not really unnatural menstrual period that's happening. It's more that we withdraw the hormones that you're taking so that it causes the lining of the uterus to shed.
So it's not that there's anything unnatural that's built up in there that we need to clear out, essentially. So there are lots of options for using medications to skip periods in a way that's safe to do that, because it's keeping the lining of the uterus thin so that there isn't anything that needs to be flushed out each month. There are also some of the progesterone only methods that you mentioned that as a seems like a common side effect.
Sometimes people might stop having periods while they're on it, because that uterine lining is staying so thin that there's just not very much left to sloughed off every month. Exactly. And speaking of those progestin, progesterone, or progestin only methods, one of the very common ones, is an intrauterine device or an IUD. I know I've certainly heard questions about whether they're, an option for younger patients, whether they're safe to use for teens.
What can you tell me about IUDs for younger people? Yeah. Are you. These are definitely safe to use in adolescent patients. By the time periods have started, the uterus has had enough exposure to estrogen that it has grown. And matured so that it's essentially an adult size. So that means that a typical IUD, like a Marina or a light letter that you would think of as an adult medication most of the time is able to fit inside the uterus of somebody who's periods just started.
A lot of kids and teenagers are nervous about the idea of having an IUD placed involves an invasive pelvic exam. It involves about a five minute crampy, uncomfortable procedure. But we do have the option for people who are nervous about the pain, but do want to have an IUD that it could be placed under sedation in the operating room. I would say it's not only younger people who are nervous about that.
I think in general, there's a big conversation about the amount of discomfort in IUD placement, and it's great to know that. I think the pain management options are available for really any patient at any age who might want to get it. That's a great distinction. Another myth I saw online was that the color or consistency of period blood is like telling you something about your health that if it's brown blood, it's not as good. If it's light pink, it's telling you something else.
And I was very curious. What do the period blood changes over the course of a cycle? A little bit. There's a little bit of variance for every person. Like, is that telling us anything about our health? Not typically. Period. Blood can be. You're exactly right. A variety of different consistent use colors. Sometimes it feels more like tissue, sometimes it feels more watery. And all of those are in the range of normal.
It's often common for people to start off a period by having lighter spotting that might be brown, or that might be pink, or might be red, and all of that is normal. Typically, on the heavier days, people have bleeding that looks more like what you would think blood looks like. And then the tail end of the period often ends up looking more brown. We can also see that when people are on hormonal medications, that that can change the consistency and color of your period.
And all of that is considered normal. When you mentioned tissue. Can you tell me what the sometimes period blood can be a little cloudy and thick and what's going on when that's happening? And is there a point where like too much clot and thickness is something you'd want to get? An opinion about? Yeah. I think when people pass clots with their period, it can be really alarming.
Totally. Understandably so. Most of the time when clots come out, what's happening is that the blood is coming out through the uterus and cervix. It's able to pool in the vagina for some period of time. And then when the person stands up, that blood that's been sitting there has sort of congealed into a clot and may come out all at once.
Small clots that are like time sized or smaller are considered to be normal if people are passing clots that are like that double the size of the palm of their hand, then that is more bleeding than I would expect, and I would want them to bring it up with the doctor. For young people and supportive adults in their lives who maybe want to start talking about have questions about periods but don't know quite where to start.
What is your top tip for getting that conversation started in in your family or with your supportive adults? So I think I've learned this in my own practice that I usually recommend starting with what the kid already knows. Often they've heard misinformed or interesting things from TikTok that their friends have told them. So I think starting off the conversation asking, have you ever heard of what a period is? Do you know what a period is? And starting from there?
For people who like to do some research before they talk to their children about things or their loved ones. Some websites that can be helpful are, Scarlet Incom or Kid's Health, that org. Those both have pretty good information. There's also a pretty good book out there called Welcome to Your Period by Doctor Melissa Kang. And you meet times.
Those are geared a little bit more towards the older kid or teen, but I think have some good information to help equip parents with how to talk about these issues. All of those resources will be linked in the, episode description for this episode, so folks can find them really easily. So my final question for you then is, what do you think is the most important thing for young people to understand about periods? I wish that nobody felt embarrassed about their period.
Periods are just a natural, normal process of what our body does. It's unpleasant to go through, but it's not anything shameful or anything that you should be embarrassed to talk about with, especially with your family or with your friends, especially with your doctor. If you are somebody who's struggling with heavy periods or painful periods or periods that have stopped or you're 15 or older and your period hasn't started yet, I want you to feel comfortable going to the doctor about it.
Thank you so much for joining us, Doctor Brian. Yeah, thank you so much for having me. All the resources doctor O'Brien shared are linked in this episode's description. The Women's Health Cast is a production of the UW School of Medicine and Public Health Department of ob gyn. This episode was produced and engineered by Rob Garza. OB gyn communications intern Paige Stephenson provided research and interview support.
You can listen to the Women's Health Cast on Apple Podcasts, Spotify, or wherever you get your podcasts, and you can find the UW department of ob gyn on social media under the handle app. We're si ob gyn. Let us know how we're doing. Rate and review us in your podcast app, and let us know what health issues you'd like to learn about at the link in our episode description. Thanks for listening.