How to prepare for your first menstruation and what you need to know about it?

Menarche (Greek men - month + arche - beginning), first menstruation; the main sign of puberty in the female body, indicating the body’s ability to become pregnant.

Menarche begins in most girls at the age of 12-13; the time of onset depends on the physical development of the body, nutrition, previous diseases, social and living conditions, etc.

Harbingers of menarche can be “unreasonable” changes in well-being: fatigue, weakness, excitability or attacks of despondency, headaches, dizziness, pain in the lower abdomen, nausea, etc. A preliminary conversation will help prepare for this event.

In the absence of the necessary information, the appearance of bloody discharge from the genital opening can cause false shame, fear and even attempts at self-medication, which is fraught with tragic consequences. An earlier onset of menarche (8-9 years) indicates premature puberty or the development of a hormonally active ovarian tumor.

When menarche occurs at 15 years of age or later, the presence of sexual infantilism can be assumed.

Sometimes a later or earlier onset of menstruation in the absence of special circumstances is not considered a deviation from the norm.

It may be associated with the late onset of menarche in the mother, constitutional features (in girls who are inclined to be overweight, it occurs earlier than in thin ones), the influence of intense sports activities (for example, gymnastics classes slow down the onset of menarche, swimming speeds it up), etc. In all these cases, consultation with a gynecologist is useful. The time of menarche is associated with the development of sexual sensations. Considering that puberty occurs earlier than physical and spiritual maturity, early sexual activity can adversely affect the girl’s fragile body and the development of the offspring.

(Source: Sexological Dictionary)

Source: https://dic.academic.ru/dic.nsf/seksolog/121

Formation of secondary sexual characteristics

Towards the beginning of phenotypic changes in connection with the regeneration of the reticular zone of the adrenal cortex, adrenarche occurs (at 6-8 years). Gonadarche (around 8 years of age) occurs with the onset of stimulation by gonadotropin-releasing hormone (GnRH) of the anterior pituitary gland to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This in turn triggers the onset of subsequent physical changes, including breast development (thelarche), development of pubic and axillary hair (pubarche), growth spurt, and onset of menstruation (menarche), usually in that order. Adrenarche and gonadarche are not parts of pubertal development.

Behavior rules

Some people associate their first period with illness. But that's not true. Menstruation should not affect the rhythm of life. You just need to follow certain recommendations.

• Hygiene. The underwear should be breathable and made of cotton. It needs to be selected according to size. Menstrual blood is an excellent breeding ground for microorganisms. If you neglect the shower, not only will an unpleasant odor appear - the metabolic products of bacteria are toxic to the human body.
• Gaskets. You need to use ones that correspond to the amount of bleeding. Change when full, but at least once every four hours.
• Tampons. Special tampons have been developed for teenagers. They are not capable of damaging the hymen. During menstruation, under the influence of estrogen, it becomes elastic and folded, so it is not an obstacle. It is impossible to use tampons only if there are anatomical features of the development of the genital organs. In the first days of bleeding, changing the tampon should be done every four hours. In subsequent days - less often, up to eight to ten hours. If you change it very often, the vaginal mucosa will become dry and will not allow you to insert a new one, or irritation will occur.
• Physical training . Playing sports and attending physical education classes is not prohibited. Only if you feel very unwell in the first days, you can refuse physical activity. In other cases, exercise will be beneficial. They help reduce unpleasant symptoms, abdominal pain, and keep the body in good shape. But you should avoid lifting weights and working on your abs so as not to increase bleeding.
• Sex. After the appearance of menstruation, some girls begin sexual relations. If you follow the rules of contraception and hygiene, they will not cause harm. But you should not use the days of menstruation for unprotected intercourse to avoid pregnancy. At this time, the risk of contracting a sexually transmitted infection increases because the cervix opens slightly and there is no acidic environment in the vagina to protect against bacteria.

Hormonal changes before puberty - adrenarche and gonadarche

Adrenarche - an increase in the production of androgens by the adrenal glands - occurs between the 6th and 8th years of life. In the adrenal glands, regeneration of the zona reticularis, which was suppressed immediately after the birth of the girl, begins, with a concomitant increase in the activity of P450 microsomal enzymes. This inner layer of the adrenal cortex is responsible for the secretion of sex steroid hormones. As a result, the production of androgenic steroid hormones of the adrenal glands - dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA) and androstenedione - increases, which occurs from 6-8 to 13-15 years.

Gonadarche - the establishment of normal ovarian function - begins around 8 years of age, when pulsatile secretion of GnRH by the hypothalamus increases. This leads to stimulation of the synthesis of gonadotropins FSH and LH by the anterior pituitary gland, occurs mainly during sleep and is not accompanied by any phenotypic changes.

The first sign of puberty is an increase in pulsatile LH secretion at night. This pulsatile secretion of LH at night is reversed by pulsatile secretion of LH and FSH during the day, which leads to an increase in estrogen levels due to the growth of follicles in the ovaries. Positive feedback from the increase in estradiol levels initiates the LH surge necessary to induce ovulation.

Adrenarche is not necessary for normal ovarian function - gonadarche. This is confirmed by the fact that patients with hypofunction of the adrenal cortex have normal pubertal development. The ovaries, in turn, can begin to function before adrenarche in case of premature pubertal development. On the other hand, gonadal function is not necessary for adrenal function, as evidenced by normal adrenarche in patients with gonadal dysgenesis.

The first phenotypic change during puberty in most cases is the onset of mammary gland development (thelarche), which occurs around 10 years of age. But sometimes there may be an increase in the rate of linear growth 1-2 years before the onset of thelarche, signaling the onset of pubertal development.

After thelarche, pubic hair growth, pubarche, begins to develop (often together with axillary hair), which occurs around 11 years of age. Further events are usually the pubertal growth spurt (9 cm/year), which occurs around age 12, and finally menarche around age 13. Menarche usually occurs 2-2.5 years after thelarche. Normal pubertal development begins within 2.5 standard deviations from the mean, i.e. between 8 and 14 years.

Stages of Puberty

This is a complex endocrine process responsible for physical and sexual development. It lasts for several years and is divided into 2 periods: prepubertal and pubertal.

The preparatory (prepubertal) phase of menarche begins at 8-9 years old, when the first changes occur in the girl’s figure. Intensive body growth is also observed. In one year it can increase by 9-10 cm.

The puberty period itself also lasts several years. At this time, girls' mammary glands begin to enlarge and pubic hair begins to grow. The body synthesizes hormones, under the influence of which the contours of the hips and waist are formed, and the figure begins to acquire femininity. The final stage of puberty is menarche.

The age of 14-16 years completes puberty. The final formation of the mammary glands occurs, the “female” pelvis and female-type hair growth develops. Properly functioning ovaries ensure the regularity of the menstrual cycle and the timely arrival of menstruation. In most cases, the cycle lasts 28-30 days; minor shifts up to 21 or 36 days are not pathological. Delays of several months in adulthood indicate a malfunction of the ovaries and can cause infertility.

Telarche

The first stage of thelarche is the development of the mammary gland buds, usually occurring around 10-11 years of age. Thelarche is usually the first phenotypic change in a series of events during puberty and occurs due to an increase in circulating estrogen levels. Simultaneously with thelarche, estrogenization of the vaginal mucosa and development of the vagina and uterus occur. Further development of the mammary glands occurs during puberty and adolescence. Corresponding changes in the mammary glands are divided into 5 stages, according to the classification of Marshall and Tanner.

Gynecologist's opinion

The health of the reproductive system is, of course, very important for any woman. Unfortunately, understanding this usually comes very late. According to most gynecologists, the problem of young girls is not the presence of any pathologies or diseases of the reproductive system, but in relation to their body. It seems that any ailment will go away on its own, that a short skirt at -20°C is cool, that there is no need to monitor the duration of the cycle - somehow let it get better. At a doctor’s appointment, a teenager cannot clearly answer questions, does not know the basic concepts and terms of gynecology, is embarrassed and afraid.

Teachers at school shift the responsibility for sex education to parents, either because they have no time or because they are too lazy, and as a result, the girl is often left alone with misunderstanding and fear. Therefore, it is worth listening to the opinion, or rather even the request, of doctors, and in every possible way to support yesterday’s girl and today’s girl on the path of growing up. If a mother calmly and confidently tells her daughter about menstruation, that menarche requires reaching a certain age, that this is normal and not scary, then this will help avoid many problems in the future and form the right attitude towards her health.

Pubarhe

The onset of pubic hair growth usually occurs after thelarche, around 11–12 years of age, and is often accompanied by axillary hair growth. Pubarche usually occurs after thelarche, but simultaneous development of thelarche and pubarche is also normal. In representatives of the black race, pubarche may precede thelarche, which is not a pathology.

The development of pubic and axillary hair occurs secondary to an increase in the concentration of circulating androgens. Sometimes the concepts of pubarche and adrenarche are used as synonyms, but this is not entirely true. Pubarche is the development of pubic hair, which occurs under the influence of adrenal androgens after the age of 10 years in the stage of pubertal development, and adrenarche is the activation of androgen synthesis in the adrenal glands, which occurs between the 6th and 8th years of life and precedes the onset of pubertal development.

Definition of menarche and their main characteristics

The female body undergoes various natural changes throughout life. Many people are interested in menarche - what it is and how to recognize it. This term refers to the first arrival of menstruation. This is the main indicator of normal puberty. The first period usually occurs between the ages of 10 and 15 years. An earlier or later arrival of menstruation requires contacting a doctor. Various pathological processes can be diagnosed. The first time after the start of menstruation there is a possibility of periodic delays. This is a variant of the norm, which is due to the development of hormonal levels.

Your first period should begin as early as adolescence

Pubertal growth spurt

Increased estrogen secretion stimulates the production of growth hormone, which in turn stimulates insulin-like growth factor I, which promotes increased somatic growth. The pubertal growth spurt is characterized by an acceleration of the girl's growth, begins at the age of 9-10 years and reaches a maximum speed between 12 and 13 years (9 cm / year).

But this relationship is dose-dependent, and excessive estrogen levels lead to inhibition of the release of growth hormone and somatomedin-C. Subsequently, as a result of the influence of estrogens on the cessation of growth of the epiphyseal growth zones of long tubular bones, growth cessation may occur after a rapid growth spurt.

Estrogens enhance the growth of bones, especially the axial skeleton. Growth hormone has a greater effect on the growth of long bones. This explains the fact that patients with hypogonadism often have a short torso with relatively long limbs (eunuchoid habitus). With growth hormone deficiency, patients often have an appearance opposite to their genetic sex. Estrogens also promote the closure of the epiphyseal growth zones of long bones. So, patients with precocious puberty have an early onset of growth, but ultimately have short stature due to premature closure of the epiphyseal growth plates if timely treatment is not carried out.

Features of the course of the first menstruation

The main thing you need to know about menarche is that it is completely different and should not be similar to menstruation for an adult woman. This is just the beginning; “launching” the normal functioning of the reproductive system and stabilizing all processes will take years. The first menstruation may be:

1. Short. Even 2 days is normal, so if your period starts and ends immediately, don’t panic.
2. Long. The situation is the opposite, the discharge lasts 7–10 days, or maybe two weeks, which frightens both the girl and her parents. However, this is also a variant of the norm, although on the 15th day of bleeding you should still consult a doctor.
3. Meager. Throughout the entire menstruation, the discharge may be spotting, this is also not scary.
4. Abundant. Normally, a woman loses up to 80 ml of menstrual blood, but even such an amount may seem excessive to a teenage girl. It is important to explain that the discharge is considered abnormally heavy when it is necessary to change the largest sanitary pad more than 4 times a day. Everything else is normal.
5. Painful. The majority (about 90%) of girls complain of abdominal pain, weakness and poor health. The best option would be to relax for a day or two at home, avoiding physical activity, calm down and do what you love. In many ways, pain is associated with stress, so the right attitude is better than any painkillers.

The parents' task is to record the onset and duration of menstruation, and also to teach this to their daughter. It must be remembered that a girl may misinterpret her feelings, so it is important to establish a level of trust that will allow parents to receive the most detailed information about what is happening.

Menarche

The average age of menarche (first menstruation) ranges between 12 and 13 years (12.7 years). Menarche usually occurs 2 years after thelarche (development of the mammary gland buds). The menstrual cycle in adolescents is usually irregular during the first 6 months to 1 year after menarche, indicating anovulatory cycles. The establishment of regular ovulatory cycles begins approximately 2 years after menarche.

Delayed menarche can occur in gymnasts, long-distance runners and ballerinas. It has been suggested that the signal for the onset of menarche is the achievement of a certain body weight (17-22% body fat), usually occurring at body weight > 45 kg. But there is no exact data on what affects the delay of menarche more: lack of adipose tissue or stress and physical activity.

Ovulatory menstrual cycles are accompanied by an increase in progesterone levels after ovulation. Ovulation is usually inconsistent for 1-2 years after menarche, resulting in irregular menstrual cycles. After this period, the menstrual cycle in adolescents should become established, and the absence of regular cycles may indicate reproductive disorders.

Girls' first periods

The first menstruation (called menarche) is an important event in a girl’s life. As a rule, it is not unexpected - older girlfriends inform. And under the influence of these conversations, some girls are even afraid of the onset of menstruation.

Unfortunately, for some reason many mothers are embarrassed to talk in detail with their daughters about this, limiting themselves only to hygienic advice.

But a girl needs to know that the onset of menstruation marks an important milestone in puberty. Since there is menstruation, it means pregnancy is possible.

Another thing is that the girl’s body is not yet developed enough, and therefore pregnancy and childbirth can become an overwhelming test for her. Obstetricians are aware of cases of very difficult births in girls aged 14-15 years...

The first menstruation usually appears at age 13, plus or minus a year. Fluctuations in one direction or the other may be somewhat greater. But, if menstruation began very early (before 10 years) or very late (after 15), some trouble may be suspected, and the girl should be shown to a doctor.

The reasons for delayed menstruation are varied: sometimes it is an individual characteristic of the body, sometimes the result of infectious diseases suffered in early childhood or emotional stress, physical overload, as happens, for example, in girls who do gymnastics too intensely and uncontrollably. It may also be a sign of an endocrine or other disorder.

Menstruation is the final stage of a complex chain of processes that rhythmically occur in the female body. Each such cycle lasts 28-30 days, sometimes it is shorter - 21 days and longer - 35 days.

What happens during the menstrual cycle, that is, during the period from the first day of one to the first day of the next menstruation?

The cycle is divided into two phases. The main event of the first is the maturation of the egg and its release from the ovary; this period is characterized by the activity of special hormones—estrogens—in the body; in the second phase, another hormone, progesterone, becomes dominant.

Under their influence, changes occur in all hormone-dependent organs: the uterus, fallopian tubes, vagina, mammary glands. But the mucous membrane lining the uterine cavity changes most of all.

Its blood supply increases, it swells and becomes loose.

These changes are designed so that in the event of pregnancy, the fertilized egg, which by this time, having moved through the tube, enters the uterus, can reliably attach here and begin to develop. If fertilization does not occur, the swollen mucous membrane is rejected along with the unfertilized egg. This is menstrual bleeding.

For many people, a rhythmic menstrual cycle is not established immediately, but after about six months or a year. Before this, menstruation can occur more often or less often, sometimes very scanty, sometimes, on the contrary, abundant.

On the eve of menstruation, girls often complain of heaviness in the lower abdomen, mild headache, and weakness. These are natural phenomena and should not cause concern. By the way, some girls during menstruation are extremely irritable, touchy, and their mood deteriorates. You need to learn to overcome such reactions, otherwise it will be difficult for yourself and unpleasant for others.

During menstruation, mental and physical performance does not decrease, and the girl can do all her usual activities without changing her usual routine. You can do morning exercises, abstaining only from exercises associated with large overloads.

Running, cycling, skiing, skating, and swimming are contraindicated, as this can lengthen the duration of menstruation and increase blood loss.

Swimming is also prohibited due to possible cooling and the risk of infection entering the uterine cavity, since the natural mucous plug that usually closes the cervical canal is absent during menstruation. There is no need to take a bath these days.

Hygienic procedures include washing two or three times a day under a running stream of water - from a jug or under a shower, a shared shower every day if possible, and in any case, at least once a week. You need to use special pads or cotton wool and change your panties daily.

Menstruation lasts on average 3-5 days, and not much blood is lost - from 50 to 100 milliliters. If its duration is longer, and the blood loss is greater, if the girl experiences a sharp headache, cramping pain in the abdomen, severe weakness, it is imperative to contact the pediatric gynecology office or an obstetrician-gynecologist at the antenatal clinic.

I want to warn parents: a teenage girl cannot yet distinguish what is natural and normal in these new phenomena for her, and what signals trouble.

The development of her menstrual cycle must be carefully monitored. First of all, this is, of course, the mother’s business. If a doctor offers treatment, you cannot refuse.

After all, the daughter’s future motherhood and her marital happiness may depend on whether or not measures are taken in a timely manner!

A. Zavodova, Doctor of Medical Sciences

Source: https://domashniy-medic.ru/menarkhe

Disorder of pubertal development

Normal pubertal development begins between 8 and 14 years of age (±2.5 standard deviations from the mean). If a girl develops secondary sexual characteristics at age 8, or if secondary sexual characteristics are absent before age 14, or if a girl with developed secondary sexual characteristics does not menstruate before age 16, such patients are subject to additional examination.

For representatives of the black race, puberty can normally begin before the age of 8 years. Isolated premature thelarche or pubarche without other signs of pubertal development may occur, does not require urgent examination, but indicates the need for observation to exclude possible premature pubertal development. Premature thelarche usually occurs in the first 7 years of life, and premature pubarche may be an early sign of polycystic ovary syndrome later in life. Precocious pubertal development is more common in girls (5 times more common than in boys), and delayed pubertal development is more common in boys.

Pubertal development may begin earlier due to the following circumstances:

• in patients with a family history of early pubertal development;
• among representatives of the black race; when living in the equatorial zone;
• when living low relative to sea level; in urbanized cities;
• for obesity;
• in case of blindness.

Late onset of puberty can be observed:

1) with diabetes mellitus;

2) with significant degrees of obesity;

3) with insufficient nutrition;

4) with excessive stress and physical activity.

How different peoples celebrate their first menstruation

The appearance of menstruation (menarche) is an important event in the life of every girl who grows from a child into a young woman. Every month, her uterus begins to produce an egg so that the woman can become pregnant and carry a child to term.

We are relaxed about menstruation. Mom explains to her daughter the basic rules of hygiene and behavior these days.

Critical days are a very personal, intimate thing; they don’t talk about it openly in our society. But this is our case, but some peoples treat this physiological process as a sacredly important, special sacrament and even celebrate it.

How menarche is treated in the East

So, in some countries, a girl is obliged to immediately share such a joyful event with all her relatives. The fact is that, for example, in Afghanistan or Pakistan, menarche (first menstruation) is a sign of a girl’s puberty. This means that she can get married soon.

If you watched the TV series “Clone,” you probably remember how desperately Muhammad waited for his daughter Samira to mature and even planned to send her to the doctor. He was afraid that such a delay in her development was a sign of infertility. And this is very scary for an “eastern” girl.

For Moroccan women, menarche is the moment when their lives change. For example, from now on they are required to wear a scarf to hide their hair and neck. A woman's beauty is only for her husband. Actually, Samira, who lived in Brazil, was afraid of this moment, hiding what had long been ripe.

In general, “Clone” shows a lot of surprising things. It’s not a shame to show a sheet after the wedding night, it’s not a shame to show signs of a girl’s menarche, but it’s a shame for spouses to kiss in public...

Similarly, they are waiting for information about the maturation of girls in India. Now, however, only in villages, since early marriages are prohibited by law. However, this event in a girl’s life is a reason for her parents to start looking for a suitable groom for her. All the neighbors instantly become aware of such a piquant moment in the girl’s life.

In Rus', girls shared information about such an intimate event only with older women in their family. They prayed intensely to the gods of fertility so that their women's health would always be good, and that in the future they would be able to bear and give birth to a child.

A special ritual to celebrate the first menstruation

In Mozambique, girls are prepared for adulthood from an early age. They are told that the only goal in their life is to find a good husband and give him healthy children. Therefore, girls take especially careful care of their women's health.

Mothers always pay close attention to when the first signs of puberty appear in their daughters. As soon as a girl started menstruating, all the women in her family helped her mentally prepare for adulthood.

She was forbidden to leave the house and communicate with her friends for several weeks. The girl learned basic hygiene rules. She did her own laundry.

During the second week of her imprisonment, she listened to the advice of her relatives on how to behave with a man. Gradually she prepared for marriage and motherhood, drinking a special tincture of salt and herbs.

And in the last weeks of her imprisonment, a holiday was organized for her, during which the almost adult girl was dressed in a beautiful dress.

The parents slaughter the cattle and set the table. Guests are treated to only the best dishes, and everyone has fun. The ritual of celebrating the first menstruation has existed in Mozambique for several centuries.

Parents help their child mentally and physically accept growing up. Mom makes sure to teach her daughter how to take care of herself during her period.

Superstitions related to menstruation

Some nations forbade women from leaving the house “on these days,” plowing, or helping their husbands hunt. People believed that menstruation was invented by the devil himself. Therefore, during menstrual periods, it is better for women to be isolated from society.

But this is still nonsense. But nowadays in Nepal, in some areas, due to wild superstitions, girls are evicted to separate cold huts during their critical days. Supposedly they are unclean these days, and therefore should not touch anyone. Due to the terrible conditions in these huts, women often get sick and even die.

This is something unprecedented in the 21st century...

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Source: https://zen.yandex.ru/media/fashion/kak-prazdnuiut-pervuiu-menstruaciiu-raznye-narody-5c0a33a11ff42300ac9849a1

Premature pubertal development

Premature puberty is the appearance of secondary sexual characteristics before the age of 8 years. In girls, about 75% of precocious pubertal development is idiopathic, while in boys it is only 40%. Modern capabilities of highly sensitive methods of intracranial imaging, in particular magnetic resonance imaging, may make it possible to identify the causes of these so-called “idiopathic” conditions.

Isosexual precocious puberty is a precocious puberty that corresponds to an individual's genetic sex.

Heterosexual precocious puberty is precocious puberty that develops in a pattern opposite to the individual's genetic sex. Heterosexual precocious pubertal development in girls reflects excessive androgen production by the adrenal glands or ovaries. Isosexual precocious development is more common than heterosexual precocious development.

There are two forms of premature sexual development : GnRH-dependent and GnRH-independent. GnRH-dependent form of precocious puberty (“true”, “complete”, “central”) develops due to premature activation of the hypothalamic-pituitary-gonadal axis, namely with early activation of the hypothalamic generator of GnRH pulsations, and is usually idiopathic.

Treatment of this condition involves the administration of gonadotropin-releasing hormone agonists (zoladex, diferelin, lupron) to suppress the premature activation of the GnRH pulsatility. One of the most serious causes of GnRH-dependent premature pubertal development are tumors of the central nervous system), in particular hamartomas. Treatment of hamartros can be surgical, radiation or medication (GnRH agonists).

GnRH-independent form of precocious sexual development (incomplete, peripheral, premature pseudopubertal development) develops due to the production of sex steroids by the ovaries, which does not depend on hypothalamic-pituitary-gonadal regulation. In some cases, peripheral hormone production can activate the hypothalamic-pituitary-gonadal axis, leading to a mixed form of precocious puberty.

The most common causes of GnRH-independent precocious puberty may be the following conditions:

• functional ovarian cysts (most common cause);
• granulosa cell tumors of the ovaries (subject to surgical removal);
• McCune-Albright syndrome is a polycystic fibrous dysplasia characterized by numerous fibrocystic bone lesions, asymmetric skin pigmentation (“coffee spots”) and precocious puberty;
• autonomous production of estrogen by the ovaries due to genetic mutations of gonadotropin receptors, which leads to their activation and premature sexual development; Treatment of this syndrome consists of prescribing an aromatase inhibitor - testolactone;
• hypothyroidism (there is a delay in bone age, in contrast to advance in all other forms, hormone replacement therapy with thyroxine is used);
• exogenous hormonal drug therapy (it is necessary to discontinue such therapy);
• steroid-producing adrenal tumors (rare, subject to surgical removal).

Diagnosis of precocious puberty and its forms begins by collecting the patient’s medical history. They find out the characteristics of the child’s growth, the peculiarities of the appearance of signs of puberty, family history regarding possible reproductive anomalies, the presence of exogenous hormonal effects, symptoms of thyroid diseases, neurological and cerebrovascular diseases (stroke).

An objective examination evaluates height, body weight relative to age standards, and weight-height ratio. The severity of secondary sexual characteristics is assessed using the Tanner scale, studies of the thyroid gland and neurological status are performed, the skin is examined for the presence of “coffee spots”, ultrasonography, abdominal and pelvic (vaginal or rectal) examination is performed to identify functional cysts and ovarian tumors.

Laboratory tests include assessment of serum levels of estradiol, LH, FSH, TSH (TSH), and human chorionic gonadotropin (hCG). In the case of heterosexual puberty, the levels of DHEAS, 17-hydroxyprogesterone and testosterone are assessed.

The most important radiological test is bone age assessment (in the bones of the left wrist) to assess skeletal maturity. Bone age was increased in all forms of premature puberty, with the exception of primary hypothyroidism (delayed bone age).

Ultrasonography is used to evaluate the pelvic organs (functional cysts, ovarian tumors) and abdominal cavity; if a tumor of the adrenal glands or central nervous system is suspected - computed tomography (CT) or magnetic resonance imaging (MRI), if McCune-Albright syndrome is suspected - bone x-ray.

Hygiene products for the first menstruation

There is a huge selection on the hygiene products market today. Finding the right products in terms of price, comfort, and ease of use is not a problem at all. The best choice for young girls would be sanitary pads. They are safe, rarely cause allergies or irritation, and help control the amount of discharge. What you should avoid are tampons, menstrual cups and caps. They can damage the hymen, and, according to some gynecologists, they provoke the development of endometriosis.

It’s good if a girl always has a pair of feminine pads of different thicknesses with her so that she can be prepared for the unexpected. At first, mom may have to supervise and help in choosing the right products until it becomes a habit. Another important skill that a child needs to develop is to be skeptical about charlatan products, namely pads that supposedly cure or protect against pathogens.

Feminine hygiene products do not and should not have any properties other than absorbing vaginal secretions.

Delayed pubertal development

Delayed pubertal development is the absence of development of secondary sexual characteristics before age 14 or absence of menarche before age 16. Failure to menarche before age 16 is called primary amenorrhea.

Patients with delayed sexual development and primary amenorrhea are classified according to the presence or absence of mammary gland development (a sign of the presence of estrogen production), as well as the presence or absence of the uterus:

1. The uterus is absent in the case of production of Müllerian inhibitory factor (anti-Müllerian hormone) by testicular tissue. In this case, the karyotype and testosterone level are determined for the differential diagnosis of agenesis of the uterus and vagina (primary amenorrhea in the presence of secondary sexual characteristics in Mayer-Rokitansky-Küster-Gauser syndrome) and congenital insensitivity to the action of androgens (testicular feminization syndrome).

2. If breast development is absent, the FSH level is assessed, which makes it possible to identify ovarian insufficiency (high FSH) or hypothalamic-pituitary insufficiency (low FSH).

3. Cases of absence of the uterus and lack of development of the mammary glands are extremely rare.

4. In the presence of a uterus and the development of mammary glands, the management of patients is similar to that for secondary amenorrhea.

The most common cause of primary amenorrhea and delayed sexual development is gonadal dysgenesis (Turner, Shereshevsky-Turner syndromes). In second place in frequency is agenesis of the uterus and vagina (primary amenorrhea in the presence of secondary sexual characteristics in Mayer-Rokitansky-Küster-Gauser syndrome), in third place is insensitivity to the action of androgens (testicular feminization syndrome).

How should personal hygiene be carried out?

It is important that during menarche the girl adheres to basic personal hygiene. Mom should explain the most basic things in advance. You need to wash yourself at least twice a day. Change your underwear to clean underwear daily, or better yet 2 times a day.

It is recommended to use sanitary pads

During your first menstruation, it is better to use pads. Doctors do not recommend the use of tampons before sexual activity begins. This is due to the fact that such a personal hygiene product is not convenient to administer and requires compliance with a number of conditions.

When choosing pads, you should take into account the intensity of discharge. You should not buy excessively large hygiene products for a girl. Otherwise, the teenager will feel uncomfortable and the risk of irritation in the genital area will increase.

For the night period, it is better to choose pads with an extended rear part. During menstruation, a girl should not take hot baths. Physical activity should be reduced.

Menstrual cycle

The hypothalamus, pituitary gland, ovaries and uterus are components of the female reproductive system that take part in the establishment and regulation of the menstrual cycle and function through positive and negative forward and feedback connections. In a genetic female fetus, at the 20th week of development, the ovaries contain 6-7 million germ cells, the number of which decreases to 2 million at the time of birth and to 300,000 before the onset of puberty.

The menstrual cycle normally lasts 28 days (variations from 21 to 35 days). Only 15% of women have a 28-day menstrual cycle. The menstrual cycle is most irregular during the 2 years after menarche and 3 years before menopause (the last menstruation in a woman’s life). Anovulatory cycles during these periods are 6-35%.

The menstrual cycle is divided into two 14-day phases: I - follicular and II - luteal, characterized by changes in the ovaries during the cycle. These phases are also called proliferative and secretory, reflecting synchronous changes in the endometrium during the same period of time. These cyclic changes occur in the superficial, functional layer of the endometrium (both its compact and spongy layers), whereas the basal layer of the endometrium is insensitive to hormonal stimuli and remains intact throughout the menstrual cycle (regenerative zone).

During the follicular phase of the cycle, the release of FSH by the pituitary gland causes the development of primary ovarian follicles. Ovarian follicles produce estrogens, which, in turn, stimulate endometrial proliferation. Under the influence of FSH, usually only one of these follicles (dominant) reaches maximum development - the stage of a mature (tertiary, Graafian) follicle; others stop developing at different stages (primary, secondary follicles).

In the middle of the menstrual cycle, around the 14th day, in response to the achievement of the maximum concentration of estrogens synthesized by granulosa cells of the follicles, a peak in LH secretion by the pituitary gland occurs. This LH peak stimulates ovulation - the rupture of the wall of the mature follicle and the release of the egg, which almost immediately enters the lumen of the ampullary part of the fallopian tube.

After ovulation, the second, luteal phase of the menstrual cycle begins. The dominant follicle in which ovulation took place accumulates luteal pigment and develops into the corpus luteum. The corpus luteum, next to the secretion of estrogen, begins to produce progesterone, which promotes secretory changes in the endometrium (decidualization, decidual reactions - accumulation of glycogen, as well as increased vascularization) to ensure implantation of a fertilized egg.

If fertilization does not occur, the corpus luteum degenerates and progesterone (and estrogen) levels decrease. With a sharp decrease in the level of progesterone and estrogen in the endometrium, ischemia and desquamation of the epithelium of the functional layer develops - menstruation (menstrual phase).

Follicular phase

Canceling the influence of estrogen and progesterone at the end of the luteal phase of the previous menstrual cycle leads to a gradual increase in the release of FSH by the pituitary gland. In turn, FSH stimulates the growth of 5 to 15 primordial follicles (eggs, the development of which is stopped at the diplotene stage in the prophase of the first meiotic division, surrounded by a single layer of granulosa cells), which means the beginning of the first, follicular, phase of the new menstrual cycle. The development of primordial (primary) follicles to the Diploten stage of prophase of the first meiotic division does not depend on the action of gonadotropins.

Of these primordial follicles, usually only 1 becomes dominant and matures into a preantral, secondary follicle (an oocyte surrounded by the zona pellucida with several layers of granulosa and theca cells). The development of preantral follicles is gonadotropin dependent.

Selection of the dominant follicle occurs on days 5-7 of the menstrual cycle. The preantral follicle secretes estrogens, accumulates follicular fluid and matures to the stage of ovulatory (tertiary, Graafian) follicle. FSH is responsible for inducing the synthesis of LH receptors and the aromatase enzyme, which is responsible for the conversion of androgens to estrogens in the growing follicle. Estrogens act synergistically with FSH and increase the number of FSH receptors in granulosa cells of the follicle, as well as their mitotic activity.

The follicle develops and reaches preovulatory maturity through the production of estrogens, which enhance its maturation and also stimulate the formation of FSH and LH receptors in an autocrine manner. Estrogens are produced by the “two-cell”, “dagonadotropin pathway”. The cells of the inner theca membrane of the follicle (papa cells) produce androstenedione in response to LH stimulation, and the granulosa cells of the follicle, under the influence of FSH and with the help of the aromatase enzyme, convert this androstenedione into estradiol.

The synthesis of androgens, which are also converted into estrogens, stimulates LH. Androgens promote atresia of non-dominant follicles. Androgens in high concentrations are subject to 5a-reduction into more active androgens. A premature increase in LH secretion also reduces the mitotic activity of granulosa cells and contributes to degenerative changes in the follicles.

An increase in the level of circulating estrogens, according to the law of central negative feedback, affects the secretion of FSH by the pituitary gland. This leads to the withdrawal of gonadotropins supporting other developing follicles. The dominant follicle is protected from a decrease in FSH levels due to the increased concentration of FSH receptors in it. In addition, increased vascularization of the inner layer of theca cells also contributes to greater sensitivity of the dominant follicle to the action of FSH. By suppressing the secretion of gonadotropins by increasing its own estrogen production, the dominant follicle optimizes its own development by stopping the growth of other follicles.

Ovulation

At the end of the follicular phase, estrogen levels increase significantly and reach a critical (peak) value (> 200 pg/ml), which is observed for about 50 hours, which is a trigger for the anterior pituitary gland to release the maximum amount of LH. This positive feedback between rising estrogen levels and rising LH concentrations is enhanced by low progesterone levels.

Ovulation occurs due to LH-induced rupture of the follicle and release of a mature egg approximately 34-36 hours after the onset of the LH rise or 10-12 hours after the LH peak. The LH surge initiates the resumption of meiosis in the oocyte, causes luteinization of the granulosa cells of the follicle and stimulates the synthesis of prostaglandins and progesterone necessary for follicle rupture. Degenerative changes in the follicle wall can develop due to the destruction of collagen, which leads to both passive reduction and rupture of the follicle. Prostaglandins and lysosomal enzymes (proteases) cause degenerative changes in the follicle wall.

Ovulation is accompanied by the completion of the first meiotic division with the release of the first polar body. The egg usually enters the fallopian tube and, thanks to the movement of the cilia of its epithelium, moves into the uterus. This process usually lasts 3 to 4 days. If fertilization of the egg does not occur within 24 hours after ovulation, it degenerates.

Luteal phase

After ovulation, the luteal phase of the cycle begins. Granulosa cells and the inner thecal membrane of the follicle line its wall and, under the influence of LH, form the corpus luteum. Life expectancy and steroidogenic activity of the corpus luteum depend on prolonged tonic LH secretion, which leads to an increase in the secretion of progesterone by the corpus luteum. Normal function of the corpus luteum requires optimal preovulatory development of the follicle (i.e., adequate FSH stimulation) and constant tonic LH support.

The corpus luteum synthesizes estrogens and a significant amount of progesterone, causes further development of glands and secretory changes in the endometrium (vascularization, accumulation of glycogen), which are preparatory processes for implantation of a fertilized egg. The peak secretion of progesterone by the corpus luteum occurs around the 8th day after the LH peak, which affects the maturation of the secretory endometrium and suppresses follicular growth.

Each day of the luteal phase is accompanied by certain microscopic changes in the glands and stroma of the endometrium. Implantation usually occurs on days 22-23 of the menstrual cycle, coinciding with the maximum intracellular apocrine secretory activity of endometrial cells.

If fertilization occurs, the developing trophoblast begins to synthesize human chorionic gonadotropin (hCG), a glycoprotein similar to LH, which provides support for the function of the corpus luteum (development of the corpus luteum of pregnancy), i.e. stimulates the secretion of estrogen and progesterone, which is necessary to maintain the endometrium until the development of the placenta and the beginning of its hormone-producing function (8-10 weeks of gestation). Insufficient function of the corpus luteum causes the so-called luteal phase defect of the cycle (luteal phase insufficiency), which is considered one of the possible causes of abortion at an early stage.

If fertilization, and therefore the synthesis of hCG caused by it, does not occur, the corpus luteum degenerates (corpus luteum of menstruation), the level of progesterone and estrogen decreases, hormonal support of the endometrium does not occur, ischemic changes develop in it and menstruation occurs - rejection of the functional layer of the endometrium.

Signs of the first menstruation

Before the onset of her first period, a girl’s mood can rapidly change; from a period of fun, she quickly falls into despondency and depression without any particular reason for this. In addition, swelling and tenderness of the mammary glands, nagging pain in the lower abdomen, and white mucous secretion from the vagina may be observed.

With normal development, the first menstruation occurs at 12-13 years of age. The monthly cycle in teenage girls is characterized by instability and irregularity. In the first year, as a rule, there is no ovulation. The onset of permanent ovulation occurs approximately 2 years after menarche. Ovulation is characterized by an increase in progesterone levels.

It is believed that the onset of menarche is influenced by sufficient body weight. Therefore, the age of menarche is often delayed in ballerinas and gymnasts. But so far scientists have not figured out what exactly is delaying the onset of menarche - a lack of adipose tissue or constant stress loads. A diet rich in proteins and minerals is also important.

The menstrual cycle is the monthly processes of the female body that occur in the brain and ovaries, and are manifested in the rejection of the uterine endometrium under the control of female hormones. This is the process of monthly preparation of the body to accept pregnancy.

The monthly cycle takes 21-35 days, bleeding - 3-7 days. At the same time, cyclic changes in the ovaries and uterus occur.

The menstrual cycle is controlled by:

1. The cerebral cortex. The bark governs the female monthly cycle.
2. Hypothalamus. The impulses of the central nervous system and the action of hormones are concentrated in its subcortical sections. The hypothalamus produces all the hormones that are transmitted to the pituitary gland and releases the necessary hormones.
3. Pituitary gland. It synthesizes gonadotropic hormones.
4. Ovaries. They produce female hormones, a follicle is formed, and ovulation occurs. In the first half of the female cycle, one or more follicles mature under the control of the pituitary part of the brain. The follicle and its components change during this period, that is, over 14 days. Ovulation is the process of the release of an egg from the follicle into the abdominal cavity and fallopian tube. Within a day, the female cell is destroyed. Luteinization is the transformation of the follicle into a gland called the corpus luteum. The corpus luteum is an overgrown layer of the follicle, yellow in color due to lipochrome pigment. The gland is destroyed after two weeks. The ovaries produce female and male hormones. Estrogens influence sex-specific changes in the genital organs and the blood supply to the uterus. Gestagens control the process of endometrial growth and transform the inner lining of the uterus. Androgens affect the growth of a woman's genital organs.
5. Uterus and vagina. The cells of these organs respond to ovarian hormones. The uterus is the central organ that falls under the hormonal action of the ovaries. The endometrial uterine layer changes monthly. During the proliferation phase, the inner layer of the uterus is restored under the influence of estrogens. During the secretory phase, the endometrial lining swells and prepares to receive an egg. If the egg is not fertilized, the amount of progesterone and estrogen decreases, the endometrium is rejected, and menstruation begins.

Menarche occurs differently in girls, but the symptoms of its approach are approximately the same for everyone. A girl can feel the approach of the first regula a couple of months before their arrival, and the following signs may be present:

• nausea;
• irritability;
• bad or, conversely, excessive desire to eat;
• deterioration of the skin condition.

A nagging pain may occur in the lower abdomen in the lumbar region. Headache and dizziness may also occur. The girl feels general fatigue and weakness. Parents may be struck by their daughter's often causeless mood swings, as well as increased emotional excitability. The child’s behavior and well-being are similar to female PMS.

During the first menstruation, the discharge is quite scanty, and ovulation does not occur in every cycle. At this time, the probability of getting pregnant is very small, although it exists. The intensity of discharge will fluctuate until the functioning of the reproductive system improves.

The first menstruation should not last less than three days; normally it lasts 4 days and has an average intensity of discharge. During the first two days, the girl may feel nagging pain in the lower abdomen, this is normal, but if they continue throughout the entire period of menstruation, you should consult a doctor. The child may have dysmenorrhea, which requires mandatory treatment.

This disease is diagnosed when there is an increased amount of prostaglandins in the blood, substances under the influence of which the uterus contracts intensely, thereby causing cramping pain in the lower abdomen. Dysmenorrhea may indicate the presence of pathological changes in the reproductive organs or an abnormal position of the uterus. Treatment of this disease is necessary to prevent the development of more serious health problems, including infertility.

WHAT TO DO BEFORE YOUR FIRST PERIOD COMES?

Girls' first period is an important and very significant event. It is difficult to describe the feelings that you will experience. During the first period, a teenager will have to deal with strange and new sensations. There may be thousands of thoughts running through your head at once, but you have nothing to fear. On the contrary, it would be reasonable to think: “When I get my period, I will really become an adult.” You must prepare for this exciting event. Try to relax and unwind. Whenever your first menstruation begins, remember: this is a natural process in the female body, thanks to which a girl can perform a real miracle - give life to a baby.

WHAT DOES YOUR FIRST PERIOD LOOK LIKE?

Girls' periods usually start with light brown spots or a few drops of blood that you notice on your underwear. The color of the discharge can vary greatly from girl to girl, and also change depending on the day of the cycle. Menstrual blood is usually red, brown, or even dark brown in color. The first period looks different because it consists not only of blood, but also of the lining of the uterus (endometrium), as well as vaginal discharge.

Most often, the first periods are not too intense. However, it may also happen that the discharge turns out to be quite abundant from the very beginning. In any case, don't worry. This is absolutely normal! Find out here which is better for you: a tampon or a pad.

WHAT TO DO IF YOUR MONTH STARTED?

If a girl’s first period begins unexpectedly and at the most inopportune time, it’s so easy to get confused. Don't worry! You can feel more confident if you regularly use panty liners. For example, Carefree® will protect your clothes from unexpected discharge and give you peace of mind. In addition, you can always carry tampons or regular pads with you. This will allow you to always be ready for the onset of menstruation and, if necessary, promptly use hygiene products.

For the first time, girls' periods cause real excitement. Here are some simple tips for teens to avoid being caught off guard by their period:

• Keep a menstrual calendar so you know approximately when to expect your period.
• Use panty liners (such as Carefree®) on days when you might start to leak.
• If you get your period for the first time and you don’t have tampons or pads with you, don’t hesitate to ask a friend, teacher or school nurse.
• On a day when menstrual bleeding may occur, go to the toilet every 3-4 hours so as not to miss the onset of bleeding.
• In the first critical days, just in case, you can put in your purse not only tampons or pads, but also a spare pair of underwear.