American girls usually get their first period sometimes between the ages of 9 and 16 years. The average at menarche, as this is called, is about 12 ½ years. About 2 to 3 years beforehand, you'll notice the beginnings of puberty - development of breast tissue. The time interval between your breasts beginning to develop and your first period may actually be as short as 6 months or as long as 5 years. Breast development is followed by the first hairs "down below." These are called pubic hairs. (In about 10 percent of girls, pubic hairs appear before breast growth has started.) During the time before the first period, your body grows quite rapidly and you will gain weight. About 3 to 6 months before menarche, you'll probably notice a clear or whitish mucus discharge on your underpants. This discharge is completely normal. It signals that the hormones that have caused these other changes are now affecting your female reproductive organs. These organs include the uterus, in which one day a baby may grow, and the vagina, which is the passageway from the uterus to the outside of the body. The uterus makes small amounts of secretions to help keep it healthy. These then leave the body and are noticed as the normal discharge mentioned above. Finally, one day you notice blood on your underwear or when you wipe yourself at the toilet: your first period has begun! This does not mark the end of puberty, however. You will continue to grow after your first period (although usually no more than 2 inches) and you will gain additional weight, as well. More axillary (armpit) hair appears, and pubic hair grows and spreads across a somewhat larger area. You will probably also develop thick, darkly pigmented hairs on the inner side of your upper thigh. Your breasts will continue to grow until you are 17 or 18 years old.

Getting your period probably also means that you, along with virtually every other girl, have questions or concerns about them. What's normal? What's not? Here are some answers to some frequently asked questions.

I'm 14 years old and I haven't had my first period yet. Is something wrong with my body?
Probably not. If you've already noticed breast growth and tenderness, it's a good sign that your body is making the hormones it needs to develop. Usually, girls have their first period within 2 to 3 years of the beginning of breast development. If your breasts haven't started to develop yet, or if it has been longer than 2 to 3 years since development began and you still have no periods, then you should see your pediatrician for a check-up.

What is a "normal" period like? How often will I get it? How long does it last? How much bleeding is normal?
Every body is different. But there are some general guidelines about what is normal. Lots of girls think they are supposed to get their period every 28 days. Actually, the normal time interval between periods can be as short as 21 days, or as long as 35 to 40 days. Your periods will most likely not be "regular" until 2 or 3 years after menarche. It's a good idea to keep track of your periods on a little calendar that you keep with your menstrual supplies. If you ever start to feel that your period is late, you can check your calendar to see how long it's been. If you need to see a doctor for any problems related to your periods, the doctor would like to see your calendar.

Periods can last anywhere from 2 to 3 days up to 7 days. Rarely a girl may have a period lasting as long as 10 days. As long as the bleeding is not heavy (see following), that is OK.

Light or short periods are not a problem for most girls. You are more likely to be concerned that your flow is too heavy. It's really difficult to figure out how much you are actually bleeding. Normally, girls lose less than ¼ cup of blood with each period. That is equal to 10 to 15 soaked tampons or pads. Some girls change pads or tampons very frequently in order to have as little staining as possible. Other girls find it difficult to change more than a couple of times during a busy school day. So, it's hard to "count pads" as a reliable indicator of amount of bleeding.

Bleeding is usually heaviest during the second and third days of the period, and you may soak 6 or 8 pads a day. If your flow after the first few days is so heavy that a super-absorbent pad is nearly always soaked after a couple of hours, that is probably too heavy. If you're concerned that your flow is too heavy, it's always a good idea to see your pediatrician. The doctor may do a blood test to see if you are anemic or have any medical problems.

I'm 13 years old and I'm on the swim team. Is it okay for me to use tampons, so that I can swim during my period?
Lots of young girls wonder whether it's okay to use tampons. It certainly is, from a medical standpoint. Sometimes a girl's mother is worried that her daughter will "lose her virginity" if she uses tampons. Again, from a medical standpoint, you won't. Start with junior or slender tampons and follow the instructions in the box. It is safe and hygienic to use tampons when you're in a swimming pool.

What is toxic shock syndrome?
Some people may still be concerned about the risk of toxic shock syndrome from tampons. This was a problem about 25 years ago. At that time some tampons were made of a super-absorbent material so that they could be left in the vagina longer. The blood on the tampons allowed the growth of an uncommon bacteria that made a number of women extremely ill. Tampons are no longer made from this super-absorbent material and the risk of toxic shock syndrome is extremely low. You should change tampons frequently, at least every 8 hours. Never put more than one tampon in your vagina at a time. There is information about toxic shock syndrome inside every box of tampons.

I have bad cramps with my period. Why is this? What can I do?
At least 50 percent of girls and women experience some pain ("dysmenorrhea") with their periods. Some girls have such severe cramps that they miss school. You might have heard that this is something you just have to "suffer through." Not true! There are highly effective treatments for cramps. They include medications you can buy without a prescription. There are also special prescription-only pain medications. Occasionally, hormones like those in the oral contraceptive pill are the best treatment.

In girls your age, cramps are usually caused by hormones made in the uterus after the egg is released. The hormones cause the muscles of the uterus to contract. These contractions help expel the menstrual blood. If your uterus makes large amounts of these hormones, the contractions can be painful. The pain may be mild or severe. Girls who have severe cramps may also have headaches, diarrhea and vomiting as well. Girls with this type of dysmenorrhea usually don't get cramps until they start ovulating, about 2 years after menarche. So, girls may have cramps with some periods, but not with all of them.

Non-prescription medication such as ibuprofen (Advil^TM and Motrin-IB^TM are examples) relieves cramps for most girls. Take 1 or 2 tablets (200 - 400 mg) as soon as your period starts. Then, take 1 to 2 more tablets every 6 hours. If your cramps are mild, the lower does may be enough. If the pain is moderate to severe, start off with 2 tablets (400 mg) every 6 hours. Since cramps tend to occur during the first 2 to 3 days of the period, most doctors recommend you continue to take the medication throughout this time. Take it continuously, rather than waiting until the cramps start again. Just don't take more than 1200 mg in a 24-hour period unless your doctor advises otherwise.

If ibuprofen doesn't relieve your cramps, see your doctor. There are other treatments that can help. Sometimes cramps are caused by abnormal medical conditions that need a different treatment.

Will anything other than medication help my cramps?
You may have heard other suggestions for treating cramps from your mother or friends. First, a reminder: you do not have to "just put up with it." You do not need to miss school, sports or fun activities because of cramps. You just need to find an effective treatment.

Here are some (medically unproven) suggestions you may have heard from others:

1. Exercise helps? There is no evidence that exercise makes cramps more or less severe. If you usually exercise or do sports, feel free to continue doing them unless you are too uncomfortable to do so.

2. Stay in bed? Do stay in bed if that makes you more comfortable. But many times, a dose of ibuprofen (discussed above) will relieve your cramps. If you then feel well enough to get up and go out, by all means do so. Just be sure to have your medication on hand for when your next dose is due.

3. Put a hot water bottle or heating pad on your lower abdomen? There is absolutely nothing wrong with this. The uterine muscles that are causing your cramps are pretty far beneath the skin, though, so it may not make a big difference. Lots of girls find the warmth to be comforting, which in turn may help the pain diminish. So go right ahead.

4. Drink herbal teas? So far, we don't have information that proves that any particular herbal tea is effective at treating cramps. But a warm cup of tea helps lots of things in life, so there is no reason not to try this. If you are taking any other medication besides the ibuprofen we recommend, check with your doctor before regularly drinking any herbal tea that is advertised to have medicinal qualities.

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