Doctors’ Notes


Menstrual Patterns

Ah, the inevitable visit from “Aunt Flo.” It happens to every female, it ‘s never pleasant, but it is a fact of life.

As mentioned in our “Puberty Seriously?” class and our Note on Talking to Your Daughter About Periods, parents can talk their daughter through what to expect and how to manage them. But you may be wondering – are my daughter’s periods normal? Well, let’s talk about the usual patterns and when to call us if you have a concern…

When Should They Start?

Puberty can start anywhere from 8-15 years old. Once girls start with breast development, the first menstrual cycle normally occurs within 2-3 years. Every time we see your daughter in the office for a Well Visit, we look at the current stage of puberty she’s in to give you a better idea of when to expect her period.

The average age is 12.5 years, but usually occurs within 1-2 years of her birth Mom’s period.  

How Often Should They Happen?

Periods can be irregular for up to the first 2 years. She can have a period every month, every other month, 2 in 1 month, or 1 every 3-6 months. So really, almost any pattern is normal at this stage.

Girls can also have light spotting between their periods. After the first 2 years, periods should be occurring on average every 28 days, but they can range from 21-35 days. They typically last about 3-7 days.  

How Heavy Should They Be?

This can be difficult to quantify. Many girls change their pads or tampons for different reasons. They may change them every few hours because they’re full, or simply for hygiene purposes.

They may also use a variety of sizes of tampons or pads – thin or light, medium, maxi, or super. In general, periods are heaviest during the first 1-3 days. Thus, we usually ask in the office, “How many pads or tampons do you use on your heaviest day and are they soaked when you change them?”. Usually more than 4 per day indicates moderate bleeding.

We can also use a Pictoral Bleeding Assessment Chart (see below) to better assess bleeding. A score of >100 indicates heavier bleeding than normal. Heavy periods can lead to anemia or low red blood cell counts, so we screen with a finger stick hemoglobin once your daughter starts her periods. 


What About Cramps?

Cramps occur from the muscles squeezing to expel blood from the uterus. They can vary in intensity but are typically worst the first 1-2 days of a period. Anti-inflammatories work best to treat them, because they lower the protein that causes the painful inflammation and contractions. Examples of these medications include ibuprofen/Motrin or naproxen/Advil. Midol is also popular but contains Tylenol (pain reliever only) and Pyrilamine, which helps with bloating. For some girls, it helps to start these medications 1-2 days before their period starts. 

Heating pads, baths, and exercise can also be helpful in relieving cramps. 

Cramps are considered normal as long as they don’t interfere with daily functioning, like going to school. 

My Daughter Gets Super Emotional During Her Periods. Is This Normal?


Pre-menstrual syndrome, also known as PMS, is very common, affecting about 80% of girls in some way. It can have emotional symptoms like irritability, sadness, anxiety, and mood swings. Girls can also have physical symptoms, including tender breasts, bloating, headaches, and increased appetite or cravings.

Supporting your daughter through these symptoms is important, because they are driven by hormones that are difficult for her to control. With your help and guidance, she can learn coping skills to manage these symptoms

Are There Any Concerns?

Once your daughter has had her periods for 2 years, call the office if:

• She has no period for longer than 6 months

• Periods occur less than 21 days or more than 35 days apart

• Periods last more than 14 days

• She has heavy bleeding (as discussed above)

• Cramps prevent her from going to school or other activities

• She displays severe mood swings or depression during her periods.

Call us, also, if your daughter has no periods or signs of puberty by the time she turns 15 years old.

And, of course, call us in the office anytime you have any questions or concerns. We’re always happy to help!

Dr. Lisa Stefano has been a Kids Plus Provider since 2019.