Teen reproductive health issues. (Ages & Tages).

Along with the first bra and the first time she shaves her legs, a major milestone for any adolescent girl is her first period. Yet for all the anticipation of its arrival, once it begins, many girls quickly learn to despise it.

"I view it as an annoyance, something that gets in the way of doing anything," says Christy **, 15. "Having my period is a major pain in the @$$," wrote Britney **, 13, in an e-mail.

They're not just whining. Periods during the first couple of years of menstruation can be just as erratic and annoying as those towards the end, says Elizabeth L. Schroeder, MD, director of the Division of Pediatric and Adolescent Gynecology at Allegheny General Hospital in Pittsburgh. Because girls don't ovulate regularly until two to three years after menstruation begins, their periods may be erratic. Sometimes they're light, sometimes very heavy, sometimes lasting for a week, other times three days. They may come once every three months, or every four weeks like clockwork.

Adolescent girls also complain bitterly of painful cramps, with many missing school on a monthly basis due to pain. That shouldn't happen, says Dr. Schroeder. She treats patients who complain of cramps with large doses of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Lydia A. Shrier, MD, MPH, adolescent medicine specialist at Children's Hospital Boston, recommends 600 mg of ibuprofen every six hours beginning a day or two before the period starts. If NSAIDs don't work, both doctors consider prescribing oral contraceptives. The Pill reduces cramps as well as regulates periods.

"My guide for making that recommendation is whether we've tried other things, and whether (her period) impairs her functioning," says Dr. Shrier. "Adolescents have to go to school and have to be able to have social relationships, and if a kid is spending a week every month in her room because she's too embarrassed to go Out, that's a problem."

Although girls generally begin menstruating any time between ages eight and 13, (25) if they're not menstruating by 16 (and have otherwise normal sexual development), aren't having fairly regular periods two to three years after beginning menstruation or haven't developed breast or pubic hair by age 14, they should see a doctor, says Dr. Schroeder. Also check with your health care specialist if your daughter has very heavy periods. Heavy bleeding could result in anemia, or indicate a clotting disorder like von Willebrand's disease 

In addition to menstrual complaints, adolescent health specialists these days are likely to encounter sexually transmitted diseases (STDs) among teenage girls, with one study finding as many as one in five adolescent girls had an undiagnosed STD. (26) The girls she sees know about STDs, says Dr. Schroeder, but that doesn't mean they try to prevent them. "It's that issue of adolescence that says 'it can't happen to me.' Getting them to understand that it really can happen, and to take precautions is the hard part." In fact, she says, in some communities getting an STD is viewed as a badge of growing up, of being part of the "in crowd." "It's a way of saying, 'look at me. I'm all grown up.'"

Thus, all girls should be screened for STDs after their first sexual experience, says Dr. Shrier. They should also have a Pap test when they begin sexual activity or when they turn 18. (27)

** Not their real names

(25.) Tips for the Adolescent Girl, Children's Healthcare of Atlanta, www.choa.org

(26.) Wiesenfeld HC, Lowry DL, Heine RP, Krohn MA, Bittner H, Kellinger K, Shultz M, Sweet RL. Self-collection of vaginal swabs for the detection of Chlamydia, gonorrhea, and trichomoniasis: opportunity to encourage sexually transmitted disease testing among adolescents. Sex Transm Dis. 2001 Jun;28(6):321-5.

(27.) American Society of Clinical Pathology. Pap Smear; What, Who, Why & When. www.ascp.org

RELATED ARTICLE: Questions to Ask Your Health Care Professional

1. How often should my teen have a general health checkup and which health screenings and immunizations should be included?

2. When should my daughter have her first gynecologic exam and Pap test? Will this visit include screening for sexually transmitted diseases?

3. My child smokes cigarettes. Can you recommend a smoking cessation program designed for teens?

4. Does my daughter need to be concerned about her weight? Will you discuss healthy eating and weight management strategies with her?

5. When should I discuss birth control with my daughter?