Can my daughter become pregnant as soon as she starts menstruating?

For the first year or so after your daughter begins menstruating, she likely will not be ovulating. However, it’s important to note that no girl who has just started having periods should rely on this fact in the expectation that she won’t become pregnant if she has sexual intercourse. Rather, she needs to be mindful of the safe-sex precautions I spell out in other parts of this book.

How does an adolescent girl’s period differ from that of an adult woman?

A girl’s first period may be a brighter red than what you’re used to seeing, and it likely will consist of a smaller amount of blood. In fact, your daughter’s first period may really be nothing more than some spotting. But as her menstrual cycle continues, her periods are likely to become more pronounced and may remain irregular the first year.

What is an average menstrual flow?

As with adult females, the average length of menstrual flow for adolescent girls is 7 days or less. During her period, your daughter is likely to use between three and six pads or tampons per day. If her flow is significantly above this amount, you should contact your pediatrician.

For example, a heavy flow requiring changes of menstrual products every 1 to 2 hours is excessive, especially if the flow lasts longer than 7 days. Not only could this condition lead to anemia, light-headedness, or even fainting, it could also be a sign of polycystic ovarian syndrome, anorexia, tumors, other chronic illnesses, or side effects from medication, so have it checked out.

When should I expect my daughter to have her first period?

Half of all girls within the United States experience their first period before their 13th birthday. However, it’s not terribly unusual to find a girl who began menstruating when she was as young as 9 or as old as 17.

In order to put the age issue into perspective, the following statistics may be helpful: 10% of girls menstruate by the time they’re 11 years old; 90% of girls menstruate by the time they turn 14; and 98% of 15-year-old girls menstruate. If your daughter falls outside this age range, she should be examined by a pediatrician, just to make sure she doesn’t have a medical problem.

Research has shown that African-American girls typically menstruate at the earliest age, followed by Hispanic girls and then non-Hispanic White girls. (Interestingly, there aren’t any particularly reliable statistics for other ethnic groups.) Your doctor will take these facts into consideration when evaluating your daughter’s health.

What do I need to know about my daughter’s first menstrual cycle?

Typically, a girl’s first menstrual cycle is preceded by pubic hair growth. This should serve as a sign to you that your daughter’s menstruation is not too far away. Pubic hair growth typically occurs when a girl is about 10 years old. Growth of underarm hair usually follows about 2 years later. Girls have their largest growth spurt during this time period, and menstruation typically begins as well.

All of these developments are the result of new hormones swirling around in a girl’s body. These hormones are also a primary cause of the emotional roller coaster that girls experience at this age. You may very well notice an increase in your daughter’s irritability, moodiness, and even anxiety. Such reactions can first be seen at age 7 with an initial small rise of hormones, and then they spike around age 11 when the hormones go into high gear. (When that happens, your previously well-adjusted, good-natured, sweet young daughter may be a little less pleasant to be around.)

These hormones are part of an intricate biological dance within your daughter’s body. First, hormones begin to rise from a girl’s pituitary gland. These hormones then cause increased estrogen to be produced by the girl’s ovaries. Next the adrenal glands kick in, producing androgens. (Androgens are male-like hormones that contribute to hair growth in the pubic region and under the arms.) And finally, growth hormones go into their most active stage.

Interestingly, girls typically have their greatest growth spurt about two years before boys do. If you visit any fifth or sixth grade classroom, you’re almost certain to notice that the girls are, on average, taller than the boys.

Should my adolescent daughter consider breast implants?

If your daughter raises the issue of breast implants, please talk to her candidly and fully about it. Let her know your own thoughts and values regarding this issue. Make sure she realizes that all the Hollywood images of buxom babes don’t reflect reality.

And importantly, while being understanding and supportive, make it clear to your daughter that as long as she is an adolescent, you will not even consider letting her get breast implants. Explain to your daughter that getting breast implants involves expensive, invasive surgery. Therefore, it’s not something to be taken lightly. Moreover, you should point out that most plastic surgeons will not even consider performing breast surgery on someone who is not an adult. And finally, you should talk to your daughter about feeling positive about the development of her breasts, no matter what their size.

How large will my daughter’s breasts get?

Once a girl’s breasts begin developing, she understandably will be interested in how big they’ll become. However, there’s no surefire way to predict. What you can explain to your daughter is that breast size is mainly determined by genetics. As a consequence, there is no potion she can drink and no lotion she can apply that will noticeably affect the size of her breasts. (Trust me, if anyone develops such a product, it will be all over the news!)

What are some tips for buying my daughter’s first bra?

If you’re about to embark on your first experience buying a bra for your daughter, there are certain things you should know to make the task easier. First, the term “training bra” doesn’t have a precise definition. It just generally refers to any bra that is designed for a girl with little if any breast tissue. Some training bras are merely camisoles with an extra panel, some are like sports bras and are simple pieces of stretchy fabric, and others have a small cup with them.

Second, as you know, women’s bras have two numbers or sizes: a band size and a cup size. However, most training bras have only one size, starting at 28 and going to 36, and do not have a cup size. In order to determine the size of the bra your daughter needs, first measure in inches the circumference around your daughter’s chest just under her breasts. Then, if this is an even number, add 4 inches. If it’s an odd number, add 5 inches. This is the correct training bra size to look for.

If your daughter has developed enough breast tissue so that she needs a bra with a cup, you will need to make an additional measurement. You can determine her cup size by measuring her around her chest at the fullest point of her breasts. You then subtract the band number from this larger number. You will end up with a number that is anywhere between one-half an inch to 10 inches (and, on rare occasions, more than 10 inches). At the store or on the Internet, you’ll be able to find a chart that converts the number you’ve calculated to a specific cup size. For instance, “AA” refers to the smallest cup size.

Needless to say, it will be far more convenient if you take the time to determine your daughter’s bra size before leaving home. Trying to guesstimate your daughter’s bra size in a crowded store while she’s cringing with embarrassment and trying to disappear into the floor isn’t likely to be too productive. (This will be particularly true if your son proceeds to provide a running commentary of the event for all his fellow shoppers.)

Unfortunately, however, it’s been my experience after browsing in many different stores that there is very little consistency among manufacturers when it comes to bra size. Therefore, despite your best efforts, you still may need to have your daughter try on a bunch of them to get the perfect fit. In doing so, it would be very helpful to find a store that caters to girls and has helpful sales associates. (It also would be helpful to leave your son at home.)

When should my daughter start wearing a training bra?

Your young daughter may initially be oblivious to her own breast bud development. For instance, she may put on a clingy shirt and yet have no idea that it’s accentuating the breast buds that have seemingly sprung up overnight. That’s a good time for you to gently suggest it’s time for her to wear a training bra.

At first your daughter may resist the idea. However, eventually she’ll grow accustomed to the notion that she ought to wear a bra on certain occasions, such as when she has phys-ed at school. She’ll realize that the extra support makes her more comfortable during running and strenuous activities. (She’ll also learn that sweaty shirts can make breast buds look as if they magically grew.) Before long you’ll be off shopping together, looking for a new bra.

What are signs of breast problems in my daughter?

Once your daughter develops breast buds, she may experience nipple discharge. This is usually caused by irritation to the area, or by an elevated level of the hormone prolactin. Increased hormone levels may be the result of medications your daughter is taking or by a growth on her pituitary gland. Therefore, if your daughter experiences nipple discharge, you should take her to your pediatrician to be evaluated.

Your daughter may also develop a mass in her breast, even at a young age. Thankfully, the vast majority of these growths are completely benign. Although a trip to the doctor’s office is necessary to evaluate the mass, biopsies of the area are greatly frowned-upon by doctors because of the risk of damaging a girl’s breast bud. In almost all instances, the masses resolve themselves, remain without causing any problems, or disappear with the use of antibiotics.

One thing you can feel good about is the fact that breast cancer is extremely rare in adolescents. In fact, studies show that from 1998 to 2002, the incidence of breast cancer in females below the age of 20 was 0 cases for every 100,000 people. That’s right; zero cases. Now, that doesn’t mean it never happens, but it’s not something that you should spend your time worrying about.

What can my daughter do to relieve breast pain?

Unfortunately, breast pain or discomfort is common in adolescent girls. It usually happens in cycles and occurs just before she menstruates. Research has shown that this pain can be increased if a girl drinks anything with caffeine in it, whether it’s coffee, soda, or an energy drink. (And, as a further incentive not to use cigarettes, you should let your daughter know that smoking also tends to increase breast pain.)

A breast surgeon I know tells his patients who experience breast pain to avoid caffeinated products, chocolate, and peanuts; to use over-the-counter medications such as acetaminophen and ibuprofen as needed; and to wear only well-fitted, supportive bras. That’s good advice for all of us women. (Except for the “no chocolate”part, of course.)

What should I do if one of my daughter’s breasts is bigger than the other?

Breast buds are tender, raised bumps that appear directly under a girl’s nipples. It’s not unusual for breast buds to appear on just one side first. As a result, there have been many frantic but unnecessary trips to the doctor when a lump has suddenly appeared under a single nipple of a young girl.

Similarly, a mother can understandably become concerned when one side of her daughter’s chest is noticeably larger than the other. (For reasons that are not entirely understood, this usually occurs on a girl’s left side.) This is not uncommon. Approximately 25% of adolescent girls experience breast asymmetry that persists into adulthood. Later in life, corrective measures can be taken to “even out” this difference in the size of a woman’s breasts. (However, the difference between each breast is typically not that noticeable.)

Why are bladder infections more common in younger girls?

Prior to puberty, girls are more susceptible to bladder infections. This is because the urethra (which is the opening to the bladder) is in such close proximity to the rectum. Bacteria from the rectum are what cause the vast majority of bladder infections in girls. (That’s why young girls should be taught to wipe from front to back after they have a bowel movement.) It is the introduction of estrogen that begins the process of strengthening the wall between the vagina and bladder, replacing the “bad” bacteria with the “good” bacteria, and building up the tissue of the urethra, which then becomes a stronger barrier and helps prevent the remaining “bad” bacteria from entering the bladder. (Yes, sometimes our bodies seem to serve as the backdrop for a superheroes cartoon.)

What are breast buds?

In the medical community, the breast development process is referred to as “thelarche,” which is pronounced “thee-LAR-key.” (This term can come in handy if you ever want to research the issue on the Internet. If you type in “thelarche,” you’ll be directed to good, informative medical Web sites. However, if you type in any search term that includes the words “women’s breasts,” you’ll be directed to Web sites that will make you blush.)

The word “thelarche” is a Greek word that simply means “beginning of breast development.” This process starts with breast budding, which usually happens when a girl is between the ages of 8 and 10. However, some girls’ breast buds appear significantly later in puberty, and as surprising as it may seem, breast development that begins as early as age 3 may not be deemed abnormal.

The appearance of breast buds will typically occur around the same time that your daughter undergoes a growth spurt. This budding process begins when a hormone known as estradiol starts coursing through your daughter’s body. It’s this hormone that causes your daughter’s once boy-like figure to begin hinting at its future femininity.