Chances are that most women reading this never had a gynaecological scan before the age of 20. While it was not something done on children and teenagers in our time or our mothers' time, it is certainly something to consider for our daughters.
Datuk Dr Nor Ashikin Mokhtar, founder and executive chairman of the Primanora Medical Centre, advises mothers to take their daughters to a gynaecologist and get a scan done within the first three years after the child has started menstruating.
“I'm now seeing younger and younger girls with tumours inside them. I don't know what they are eating and drinking now but we now have younger girls who come in with big ovarian cancers and fibroids; they can get as big as 1.4kg. These things are hormone dependent and it would seem that perhaps it starts to grow when she starts having her menses. Sometimes there are no symptoms.
“This is what I want to share with young girls: You've got your period now – that's fantastic, but do not take your health for granted.
"At that very young age, the mother must tell them to be responsible for their body, to know what is normal because only they will know when something is not right.
“If they feel something is not right, listen to their body, come forward and tell their mother about it. Then come and have a chat with the gynaecologist. If the doctor says there is nothing wrong and you still feel something is not right, get a second opinion. If you're still not happy, get a third and fourth opinion.
“For young girls, from the time they get their menses till they get married, have a scan once every three years even if they feel they're normal. You don't know ... you cannot see or feel what is going on inside; things may be growing silently inside you. Once they get married, see the gynae every year; make your gynae your best friend,” she advises.
What age?
Girls generally get their period any time from the age of 10 to 14. Dr Nor Ashikin says mothers cannot expect their daughters to start menstruating around the same age as them.
“You might find them getting their period earlier than you and if you have more than one daughter the ages when they both get it could also differ,” she says.
Dr Nor Ashikin explains that from her clinical experience girls are getting their period at a younger age now than in the past.
“Over the years, with improved nutrition, the environment, and the fact that girls are bigger in size now, the age of menarche (first menstrual cycle) actually has dropped. It's now about 12 in developed countries and about 13 or 14 in undeveloped countries. In this case, there is a correlation between menarche and nutrition as well as the general well-being of the girls.
“You find that girls who are bigger in size tend to menarche earlier. Fat cells can be converted to oestrogen and that perhaps might have a role in bringing about menarche,” she adds.
According to Dr Nor Ashikin, the earliest age she's seen at her clinic is about 10 years old. She explains that anything earlier than that is precocious puberty, which is not normal.
Precocious puberty is caused by multiple factors – among them ovarian tumour and hormonal imbalance. Hence, if your daughter has started having her period before the age of 10, it is best to see a gynaecologist to check if everything is okay.
On the other extreme, if your daughter still hasn't started menstruating by the age of 16, you should also take her to the doctor to find out the cause of the delay.
How to prepare your kids
Unfortunately there's no guide book on how to prepare your child. There are books on menstruation and there are websites devoted to it, but ultimately, the mother's experiences will be best when it's time to advise the child.
When should mothers have that talk with their daughters?
“I would say there is no guideline for when to say it and how to say it. Perhaps when her breasts start developing and you can see some changes in her, this is the time to share with her that possibly she will be going through womanhood soon.
“Share with her that this is natural. Don't emphasise the negative aspects like it's going to be uncomfortable, painful and messy. Instead, welcome it. Explain to her that this is a phase she will go through and in some ways you could say it could be celebrated when it comes.
“Look at it from the natural side – that it's natural and it's good now that she's got it because it means she's healthy and well.
“Do tell her not to panic if she sees any bleeding. She's only going through this natural phase and that if this happens she should come to you and you could explain to her the menstrual cycle and how this will come about every month. Emphasise the biological and hygiene aspects as well,” explains Dr Nor Ashikin.
What to use
With all the options available today, what should a young girl use? Pad, tampon, reusable cloth pad or even a cup?
Dr Nor Ashikin says the choice is really up to the individual, as long as the girl is comfortable and remembers to change the pad/tampon/reusable cloth pad and drain the cup often enough.
“There are pros and cons to it and it's a matter of preference. In the United States and Europe, the tampon is definitely an option and it might even be the first option to consider. For someone who is comfortable with a tampon, it is convenient because you don't have to wear anything bulky, you don't have to worry about it leaking or even of it having a smell and you can still hide it as opposed to if there is a bulky pad.
“But the pad also has its advantages. Unlike the tampon, there isn't the risk of toxic shock syndrome. With tampons, you might end up having an infection or even toxic shock syndrome if you wear the same tampon for more than six to eight hours.
“On the plus side, the pad is definitely more acceptable in our culture. Generally, for most Asian girls who have just gotten their period, the pad is the first choice.
“On the negative side, if you don't change your pad then you can smell it, it's bulky and sometimes it might leak. But then again these days there are various types of pads to choose from which minimise these factors.
“You definitely need to change the pad and tampon within every four hours. But, of course, if the flow is heavier then change it more often.”
When to see the doctor
If there is anything abnormal like spotting in between periods or if the period is irregular, then it's time for mothers to bring their girls in to see a gynaecologist.
“It could be a hormonal imbalance which is quite common in the first one to two years after starting their menses. If their periods are more than three months apart, they should come in to get it checked out - whether it's polycystic ovarian syndrome or some other hormonal problem. That should be regulated because if you don't have your period for a while, when it does come it can be a really heavy flow and that can be scary and uncomfortable with more cramps.
“These are some of the things that mothers and daughters should know. The first day of one cycle to the first day of the next cycle should not be less than three weeks apart. Anything less than that is not normal.
“For children who have just started menstruating, it can last 2-3 days or up to two weeks. Again, anything beyond that is not normal because then she might become anaemic as a result.
“It also shouldn't be too heavy to the point that she's changing her pad every two hours or so.”
Cramps
One of the things that sometimes comes with the period is stomach cramps. The most common cause of it is primary dysmenorrhea – that means there is no organic cause, it does not lead to any condition and it is primary because of the normal anatomy of the uterus.
Explains Dr Nor Ashikin: “For someone who has not delivered before, the neck of the womb is about the size of a pinhole. So it's quite natural that when the blood and all the tissue is going to come off and the uterus is trying to squeeze it out through that pinhole that there might be a bit of a cramp.
“For pain relief of cramps, my own personal remedy is to hold a hot water bottle against my abdomen. Taking analgesics or a hot drink may also help.
“Again, just to be certain that it's not due to any underlying problem, I think the mother should bring her daughter in to see the doctor.”
PMS
Pre-menstrual syndrome (PMS) is very real, indeed, unlike what some may think.
Not all girls have PMS, but those who do shouldn't worry too much if they put on 1 or 2lb. Water retention, sore breasts, tiredness and mood swings are all perfectly normal symptoms.
For some PMS symptoms, supplements like Vitamin E (for breast soreness), Vitamin B (for cramps) and Evening Primrose Oil (said to help with the mood swings) may help.
“I think if they're getting good nutrition and a well-balanced diet, it's not necessary to put them on supplements. It's an option though if their symptoms are quite extreme.
“But you don't want your children to be popping pills from too young. It's better for them to get nutrition from food,” says Dr Nor Ashikin.
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