Teaching Menstruation Index

 

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Background Briefing

As a caring educator of adolescents, you are no doubt familiar with the physical and emotional issues associated with adolescence. The following sections can serve as a convenient reference guide and a place to turn when you want to confidently provide students and parents with specific factual information.

Menarche
Sometime between the ages of nine and 16, most girls undergo physical changes that are part of the female maturation process. One of these changes is the beginning of MENSTRUATION. MENARCHE, as it is called, is a milestone in a young girl’s life. It is a normal, healthy event, marking the biological shift from childhood to adulthood. As an educator, you are in a unique and vital position to encourage and promote the development of positive and healthy attitudes about menstruation.

With the onset of menstruation, a girl becomes aware of her emerging identity as a female capable of reproduction. Her understanding and acceptance of her new identity will be greatly influenced by the feedback she receives from peers, educators, and most importantly, her parents.

Many young girls happily anticipate the arrival of menstruation as an event to be celebrated. Some then feel let down when life continues just as it did before with no acknowledgment of a new status. You can remind your students that this event is special to young girls.

Most girls easily incorporate into their daily lives the physical changes that occur at menarche. Others may feel as if they have no control over the changes they are experiencing, especially since the menstrual cycle is often erratic at first. It takes time for young people to get used to the changes of puberty. Remind students often throughout this unit that menstruation is a natural, normal, healthy function of the female body.

Understanding Menstruation
Young adolescents want to know the facts about their growing and changing bodies. Many of the questions young girls ask reflect their lack of experience: "When will it happen to me?" or "What will it feel like?" or "Are tampons safe?" However, students may not ask pertinent questions, such as "Why do females menstruate?" and "Why does it happen once a month?" So it is important to answer these questions, providing the basic foundation for understanding menstruation.

In order for students to understand the process of menstruation, they need to be aware of the external parts of the female anatomy and the internal parts of the female reproductive system. Then students can be introduced to how and why menstruation occurs. Young people will need time to fully understand this information.

 

Female Anatomy &
the Reproductive System

The REPRODUCTIVE SYSTEM consists of the parts of the body involved in REPRODUCTION - the process of producing a species of life.

The following review of the female anatomy provides basic information that may facilitate understanding and classroom discussion. Young students need simplified explanations. To introduce students to the female anatomy, you may wish to mention terminology and emphasize descriptions to simplify the presentation. You can review the precise anatomical terms in subsequent activities as understanding develops.

 

External Anatomy
A discussion of the external female anatomy can begin with the MONS PUBIS, a mound of fatty tissue that covers and protects the pubic bone. During PUBERTY, pubic hair begins to grow on and eventually cover the mons. Below the mons lie the soft folds of skin, called the LABIA. Pubic hair grows on and in front of the larger folds, called the outer labia. Between these larger folds of skin, there are smaller folds of skin, called the inner labia. The labia protect the parts of the body that lie between them. The labia protect the CLITORIS, a small sensitive organ located at the top of the inner labia, as well as openings leading inside the body.

Three openings connect the outside of the body to the inside. Two of these openings are covered by the labia. Urine exits the body through the first opening called the URINARY OPENING. This opening is connected to the URETHRA, which is the tube that carries the urine from the bladder to be eliminated from the body.

The second opening, called the vaginal opening, leads into the VAGINA, a part of the internal reproductive system. It is covered partially by tissue, called the HYMEN. Together, the mons pubis, the labia, the clitoris, the urinary opening, and the vaginal opening comprise the area called the VULVA.

Behind the folds of skin and toward the back of the body is the third opening, called the ANUS. This opening connects with the rectum and is the pathway for feces to exit the body.

Move your cursor over each word for definition.

fallopian tube
Lining
egg cells (ova)
uterus ovary
cervix
vaginal opening
vagina

Internal Anatomy
A number of organs located inside the body in the lower abdomen comprise the reproductive system. A tube-shaped passageway, called the vagina, leads from the outside of the body to the UTERUS. The uterus is a muscular organ about the size and shape of an upside-down pear. The narrow end of the uterus, called the CERVIX, has a small opening that connects with the vagina. An unborn baby grows in the uterus when a woman is pregnant. Connected to the right and left sides of the uterus are two thin tubes, called FALLOPIAN TUBES. Near the end of each tube, there is a small gland called the OVARY. The ovary is about the size of a walnut where thousands of tiny egg cells, or OVA, are stored. The ova reside in fluid-filled sacs called follicles. Eggs are present at birth. They mature during puberty, preparing the body for the ability to reproduce.

 

The Process of Menstruation

With an understanding of the external and internal female anatomy, students are better able to comprehend descriptions of how and why menstruation occurs.

Menstruation is triggered by a small gland located in the base of the brain, called the PITUITARY GLAND. The pituitary gland produces chemicals that act like messengers, traveling in the blood to the ovaries.

Inside the body, the reproductive system begins to function. During each monthly cycle, one of the ovaries releases an egg cell, which is smaller than a grain of salt. It enters the nearby Fallopian tube and travels toward the uterus that has a special lining of blood and tissue, called the ENDOMETRIUM. The lining grows thick as the uterus prepares to receive the egg cell.

If the egg cell is united with a male sperm cell - a process called FERTILIZATION- it will enter the uterus, attach itself to the lining, and begin to develop into a FETUS. The lining supports the growth and development of the fetus. If the egg cell is not fertilized, the lining of the uterus is not needed. Both the lining and egg cell dissolve and flow out of the uterus, through the vagina, and out of the vaginal opening. This discharge is the MENSTRUAL FLOW. When the lining is completely removed from the uterus, the flow stops.

The menstrual flow feels wet and may appear like a thin or thick fluid. It can look pink, or red like blood, or brownish. Often girls report a light discharge the first day, then a heavier flow, then lighter flow at the end. Sometimes girls experience a heavier flow, while for others the flow is quite light. All of these variations are completely normal. Most often, the flow tapers off after the first two or three days. Young girls sometimes worry about growing weak from loss of blood during menstruation. Menstrual flow is not only made up of blood but also fluids and tissue. The facts are the average loss of blood during each period is 1 2/3 tablespoons (25 cc) to 4 tablespoons (60 cc), or only about a quarter of a cup. This is an insignificant amount when considering that there are at least 120 ounces (3,600 cc) of blood in the body, and new blood is constantly being produced. The blood and tissue discharged as menstrual flow are no longer needed by the body. However, if your period lasts more than a week or it is always heavy and contains large clots and you need to wear more than one sanitary napkin or tampon at once, see your doctor. Major blood loss can cause anemia (a shortage of red blood cells), and may be the symptom of another medical problem.

The days when the menstrual flow is leaving the uterus are called the MENSTRUAL PERIOD. Menstruation is the process by which the lining of the uterus is shed periodically as menstrual flow. It usually occurs about once a month, except during pregnancy. During that time the fetus is growing and hormones (chemical substances that control the menstrual cycle) in the body do not allow menstruation. The length of each menstrual period varies from person to person, as does the amount of menstrual flow. Usually a period lasts from three to five days, though variations from two to eight days are common.

 

The Menstrual Cycle

Female development and the menstrual cycle are controlled by the delicate balance of hormones produced by glands in the body.

Hormones are chemical messengers transported in the bloodstream that are directed at various parts of the body and cause specific reactions. Stimulated by hormones from the pituitary gland, the ovaries produce the hormone ESTROGEN, which plays a major role in stimulating the physical changes of puberty, including the onset of menstruation. A second hormone, PROGESTERONE, is produced by the ovaries when ovulation occurs. From menarche (beginning of menstruation) to menopause (cessation of menstruation), the rhythmic patterns of the female cycle are controlled by these hormones.

Phases of the Cycle
Each time a girl gets her period, a new cycle begins. The cycle usually lasts about 28 days, but the length of the cycle varies. Each girl's menstrual cycle can be different. The following is based on a 28-day cycle, however, some women have cycles that last as long as 40 days or as short as 21 days.

The menstrual cycle is divided into four parts: the menstrual phase, the pre-ovulatory phase, the event of OVULATION, and the post-ovulatory phase.

  1. The menstrual phase begins the cycle. This phase is the menstrual period. During this time, the lining of the uterus leaves the body as menstrual flow.
  2. When your menstrual period is over, the pre-ovulatory phase of the cycle begins. The lining of the uterus is thin, and one of the ovaries is getting ready to release an egg cell. The lining of the uterus gradually thickens prior to ovulation.
  3. Ovulation is the event when one of the two ovaries releases an ovum (egg cell).
  4. During the post-ovulatory phase of the cycle, the egg cell travels through the nearest Fallopian tube and into the uterus. Meanwhile, the lining of the uterus continues to grow thick with blood and nutrient tissue. If the egg isn’t fertilized by a male sperm cell, the lining will come away from the wall of the uterus and disintegrate.
  5. As it starts to leave your body, the whole cycle begins again with the menstrual phase, or menstrual period.

DAY 1-14

Menstruation (Period Starts)
Pre-Ovulatory (Lining Building & Egg Maturing)

DAY 15-28

Ovulation (Egg Released)
Post-Ovulatory (Egg Travel)


Move your cursor over each phase of the menstrual cycle.

 

Hormonal Changes and the Menstrual Cycle
The changes that occur during each phase of the cycle are directly related to the rise and fall of the hormones estrogen and progesterone in the bloodstream. During the menstrual phase, while the lining of the uterus is being shed, the level of both hormones are very low. After menstruation, estrogen is released by the ovary whose egg cells, which reside in the fluid-filled sacs called follicles, are maturing. This rising estrogen level helps to stimulate the growth of a new lining in the uterus.

Ovulation generally occurs about 14 days before the onset of the next period, although this may vary with each individual and each new cycle. Usually only one egg cell is released, but occasionally two or more may be released. Following ovulation, the ovary begins producing the hormone progesterone, which causes the lining of the uterus to become thick with blood and tissue. If the released egg cell is fertilized in the Fallopian tube, it implants itself in the uterine wall, where the fetus grows. If fertilization does not occur, the egg disintegrates. Estrogen and progesterone levels decrease, causing the lining to slough off and leave the uterus.

The answer to the question, "Why do women menstruate?" is that the uterus and its lining are biologically designed to support the growth of a baby. Ovulation and menstruation do not occur during pregnancy since the lining of the uterus is needed at that time for fetal development. When conception does not take place, the uterine lining is shed in the process of menstruation. The question, "Why does it happen once a month?" relates to the fact that menstruation is a continuing or cyclical process controlled by the body’s hormones. Most things controlled by nature have a rhythmic pattern to them. However, the menstrual cycle may be disrupted or delayed for a variety of reasons.

Irregular Cycles
During the first year or two following menarche, a girl may have her period at irregular intervals. Once a pattern is established, the cycle may range from every 21 days to every 40 days, though 28 to 30 days is average.

Young girls are often concerned about having irregular cycles. If their periods are delayed for several weeks or months, they begin to wonder if they are normal. The body needs time to develop a regular pattern. A change in environment or routine or any emotional stress or illness may upset the cycle, causing the period to begin later or earlier than expected. A young girl may become overly apprehensive about an exam at school. One girl may be excited about a forthcoming trip or vacation, or she may be distressed about moving to a different town. Another girl may have lost or gained weight in a short period of time. Yet another may be in training for a sports program, gymnastic team, or ballet class, requiring intensive exercise. All of these situations can disrupt a regular menstrual cycle.

It is also common for young girls to menstruate without ovulating for the first few years after menarche. This may explain why some teens who do not experience cramps or premenstrual discomfort may begin to do so after menstruating for several years. The release of progesterone following ovulation may contribute to these symptoms.

Girls can acquire an understanding of their own cycles by keeping a personal calendar and marking off the days when their period occurs. After several months, they will have some idea of how long each period lasts and the length of their cycles. This knowledge will provide girls a sense of familiarity with the changes that occur in their bodies during the reproductive years.

 

Vaginal Secretions

Beginning at puberty, girls may begin to notice a slight secretion or discharge from the vagina. Since adolescents are highly sensitive to the changes occurring in their bodies, they will want to know if these secretions are normal.

Normal vaginal secretions, resulting from increased hormone levels in the blood, are experienced by most females. The amount and appearance of the secretions vary. After menstruation, the discharge may appear as a sticky white or clear substance. Around the time of ovulation, it becomes more abundant and slippery in appearance, like raw egg white.

Vaginal secretion that is excessive or discolored, that has an unusually strong or offensive odor, and/or that is accompanied by burning, itching, or irritation may indicate that a problem exists. She should tell her parent and see her family physician.

 

Personal Care and Menstrual Protection

Today, girls and women can choose from a wide variety of menstrual protection products to suit their individual needs. Girls will value knowing what options are available to help them manage their periods.

MENSTRUAL PROTECTION products fall into two basic categories: those that are worn externally, outside the body, and those that are worn internally, in the vagina.

Girls need to pay extra attention to PERSONAL HYGIENE once they begin menstruating.

External Protection
A wide variety of self-adhesive sanitary pads that adhere to undergarments are available. For a heavy flow, usually the first two days of the menstrual period and for overnight, there are super-maxi pads. Regular maxi-pads, thin maxi-pads, and shaped maxi-pads are designed for a moderate or medium menstrual flow and girls can use them anytime during their period. Many girls like the thin maxi-pads because they are comfortable for active lifestyles. Other girls like a shaped fit because it fits their bodies better and is more comfortable.

For girls with a lighter flow, ultra thin pads, which are small and comfortable, can be used. Girls can also use mini-pads at the end of their period when the menstrual flow is usually lighter or tapering off.

Many girls experience a daily discharge which begins about one year before the first menstrual period. A pantiliner can be worn daily to protect panties from this wetness. A pantiliner is also a good back up to a tampon. All external protection should be changed every 3-4 hours regardless of amount of staining.

Internal Protection
Tampons are a different form of menstrual protection since they are inserted into the vagina. Unlike sanitary pads, a tampon should be worn only during your period. Girls should choose the lowest absorbency necessary to control the menstrual flow. Before using a tampon, girls should read all the information found in the product package - the product insert which explains how to insert a tampon properly, and information on menstruation and Toxic Shock Syndrome. A handout of tampon information is available for students through this program.

There are two kinds of tampons: those with applicators and those without applicators. The applicator tampon features a slim cardboard or plastic plunger that helps to insert the tampon into the vaginal canal. Naturally inserted tampons (those without applicators) are inserted by guiding the tampon into place with the tip of the index finger. A naturally inserted tampon begins to absorb the menstrual flow as it is being inserted, which helps prevent staining and leaking. Girls cannot feel the tampon when it is properly positioned inside the body. Nor can the tampon become lost - a common question asked by many young girls - since the cervix blocks its movement beyond the vaginal canal. The muscles of the vaginal walls hold the tampon securely in place. The string for tampon removal must always protrude from the vaginal canal, whether it has an applicator or not.

A young girl should have a clear understanding of both her external and internal anatomy in order to insert tampons properly. She must be able to identify and locate the vaginal opening, and should follow the package insert directions for correct insertion.

Some girls are embarrassed by purchasing menstrual protection products. Since menstruation happens to all girls and women and since boys and men know about it too, there is no reason to be embarrassed or secretive about buying products. This is an important message to communicate to your students.

In 1980 TOXIC SHOCK SYNDROME (TSS) was found to be associated with the use of tampons during menstruation. When discussing tampons with your students, you should provide information about TSS. Although TSS is rare, it is important for girls to be aware of it if they use tampons because education about this disease can mean the difference between prompt recognition of it and delayed diagnosis. Care should be taken to introduce the topic sensitively so that students are not unnecessarily frightened about it. A handout has been prepared for you to distribute to your students. It is important that your students realize TSS is a rare disease (1 to 17 cases per 100,000 menstruating females each year), and that you are not trying to frighten them but rather to educate them. This is because when TSS is recognized and treated promptly, the effects of TSS are completely reversible.

Personal Hygiene
While good hygiene practices are important at all times, the need for more careful attention to personal cleanliness before and during menstruation will contribute to a girl’s comfort and confidence. Once menstruation begins, the body’s production of both oil and perspiration may increase during the days before the period is due. A review of good diet and hygiene practices can be found in the Teaching Puberty section of this website.

Proper hygiene and the use of menstruation protection products are subjects of keen interest to young girls. This information is seldom included in other health-related classes and may or may not be discussed adequately at home.

The following tips can be helpful for girls as they begin to develop personal care habits:

  • Girls should gently cleanse the external genitalia with soap and water as part of their daily bathing to help eliminate odor.
  • Following each toilet use, girls should wipe the genitals from front to back to avoid the spread of bacteria from the anus to the vulva. They should wash their hands before and after using the bathroom and whenever changing menstrual protection.
  • Underwear should be changed daily. Some physicians recommend cotton panties or those with a cotton crotch because of cotton’s superior absorbency. If undergarments become soiled during menstruation, presoaking in cold water will help loosen stains.
  • Girls should change sanitary pads every three or four hours, or as often as needed, to feel comfortable and to prevent odor from forming. Odor develops when the menstrual flow leaves the body and comes in contact with air. Tampons should also be changed as needed - about every three to four hours or sooner - to avoid undergarment stains resulting from a tampon reaching its maximum absorption level. However, do not leave it in more than eight hours. Read the package insert for directions. Many girls use a pantiliner with a tampon. Also, girls should not forget to remove a tampon. A forgotten tampon may cause an odor or may lead to irritation or possible infection.
  • Girls should wrap pads and tampons in toilet paper and place them in the wastebasket or disposal container. Tampon applicators, unless they are biodegradable, should also be wrapped in tissue and thrown in the wastebasket.
  • Young girls should plan for their menstrual protection needs when away from home. Special purse cases for menstrual pads are available, and a supply of products can be stored conveniently in a school locker. Many girls carry a pad in their purses at all times. Using a light protection product, such as a pantiliner or mini-pad, can help prevent staining on days when the period is expected, when flow is light or when wearing tampons.
  • For many girls there is a thin, clear vaginal discharge that occurs up to a year before the first menstrual period. This discharge is very common and normal. This same discharge may continue up to 4 years after beginning their period. A pantiliner may be worn daily to protect underpants from this wetness.
  • Girls should be encouraged to ask for help and to discuss their personal care needs with a parent, teacher, physician, school nurse, or other adult.

 

Premenstrual Discomfort

Most girls do not experience premenstrual discomfort; however, the following is provided in case you receive specific questions.

Most girls never experience any cramps or discomfort, maybe just a few occasional twinges. These twinges are usually just muscular contractions of the uterus. They are felt in the lower abdomen on the first or second day of the menstrual cycle. Encourage your students to exercise and stay fit. The most important thing is to encourage them to have a good attitude and not be worried or concerned about getting their periods, because it’s perfectly normal and healthy. If a girl has severe discomfort, she should speak to her parent and/or doctor.

Some girls may also experience headaches, depression, nausea, backaches, bloating (fullness in abdominal area), constipation, swollen breasts, a slight weight gain, acne, or sudden mood swings, etc. These symptoms may appear seven to ten days before the menstrual period begins, and in some cases have been linked to vitamin deficiencies, nutritional problems, and hormonal imbalance.

Girls who experience premenstrual symptoms may be able to alleviate some of the symptoms by eating a well-balanced diet, eliminating caffeine and sugar, and/or supplementing their diet with vitamins. Girls should speak to a parent and/or a doctor if their symptoms persist or become severe.

DYSMENORRHEA is a medical term for painful menstrual cramps. Cramps are usually caused by contractions of the uterus that begin about 12 to 14 hours before menstruation. Normally, they can be relieved by heat application (a warm bath or heating pad) or by medication. Routine exercises designed to strengthen the muscles of the pelvis may help to prevent or minimize cramps.

 

Problems in Menstruation

The following conditions may indicate that a problem with menstruation exists and should always be discussed with a doctor:
  • Periods that are consistently irregular and unpredictable after more than two years of menstruation may indicate that a problem exists. A menstrual pattern usually begins to appear at this time.
  • Menstrual flow that is excessively heavy (MENORRHAGIA) or prolonged, lasting more than the individual’s usual number of days, should be reported to a doctor.
  • A doctor should be consulted if severe premenstrual discomfort or cramps (dysmenorrhea) prevent normal functioning for a prolonged length of time.
  • The absence of menstruation (amenorrhea) for more than several months after periods is established may indicate a problem with menstruation. This is known as SECONDARY AMENORRHEA. While irregular cycles are common during the early menstrual years, a medical checkup is advisable if menstruation stops after a cycle is established. (Note: The sexually active teen should be aware that even one missed period is cause for a checkup.)
  • The failure of menstruation to begin by age 17 is referred to as PRIMARY AMENORRHEA. About 95% of all girls have begun menstruating by age 16. Thus, a physical examination is advisable if menarche has not occurred by age 17.
  • Any bleeding from the vaginal area that occurs between periods should be discussed with a doctor.

 

Classroom Exercises & Quizzes
with Answer Keys

Followed in sequence, these activities will help introduce your students to all the fundamental facts and concerns about menstruation.

These exercises and quizzes have been designed for in-class participation. They are meant to stimulate further discussion between you and your students.

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Introductory "True & False" Quiz
Instructions for Educators

  1. ALLOW approximately 15 minutes for this activity.
  2. READ aloud the instructions to the students.
  3. EXPLAIN that the purpose of the introductory exercise is to find out how much they already know about menstruation, and that they should not be concerned if they do not know all the answers.
  4. REMIND students that the exercise will not be graded.
  5. After students complete the exercise, REVIEW and EXPLAIN the answers provided on the answer key, allowing students to correct their own papers.
  6. ANSWER questions that may arise. POINT OUT that the more complex questions will be answered during the course of the unit.

Click here for the QUIZ FORM, followed by the ANSWER KEY WITH EXPLANATIONS. Hit your PRINT button while viewing the quiz to make a paper copy that you can duplicate and distribute to your students.

Introductory Quiz and Answer Key

Vocabulary Quiz
Instructions for Educators

  1. ALLOW approximately 15 minutes for this activity.
  2. READ aloud the instructions at the top of the quiz.
  3. After students complete the quiz, REVIEW the answers.

Click here for the QUIZ FORM, followed by the ANSWER KEY WITH EXPLANATIONS. Hit your PRINT button while viewing the quiz to make a paper copy that you can duplicate and distribute to your students.

Vocabulary Quiz and Answer Key

Group Activity - Worksheet/Discussion
Instructions for Educators

  1. ALLOW approximately 20-25 minutes for the activity.
  2. ASK students to take out a piece of paper and write down any questions they have about menstruation. TELL the students that you will collect their responses. EXPLAIN that they should not put their names on the papers so all questions will be anonymous.
  3. COLLECT the responses and CATEGORIZE the questions while students complete the next steps of the activity. SAVE the responses for the end of the activity.
  4. EXPLAIN that most girls wonder about situations they will find themselves in when they begin menstruating. STATE that it can be helpful to think about those situations and plan what you would do.
  5. DISTRIBUTE the worksheet and ASK students to write down what they would do in the situations presented. EXPLAIN that even if they have already started their periods, this can be a helpful activity.
  6. When the students have finished, DISCUSS each situation, asking for volunteers to share responses. Try to keep the discussions lively, yet be aware of girls who may be self-conscious. If your students do not come up with these suggestions on their own, offer the responses presented below in the DISCUSSION GUIDE.
  7. Discuss the additional questions submitted by students in Step 2.

Click here for the WORKSHEET FORM, followed by a DISCUSSION GUIDE to help guide your classroom conversation. Hit your PRINT button while viewing the quiz to make a paper copy that you can duplicate and distribute to your students.

Situation Worksheet and Educators Discussion Guide for Worksheet Exercise

Calendar Activity
Instructions for Educators

  1. ALLOW approximately 15 minutes for this activity or assign for homework.
  2. READ the instructions aloud and have students complete the worksheet.
  3. When they are finished, DISCUSS the answers.

Click here for the QUIZ FORM, followed by the ANSWER KEY WITH EXPLANATIONS. Hit your PRINT button while viewing the quiz to make a paper copy that you can duplicate and distribute to your students.

Calendar Activity and Answer Key

Menstruation Unit Final Quiz
Instructions for Educators

  1. ALLOW approximately 15 minutes for this activity.
  2. READ aloud the instructions to the students.
  3. When students have completed the quiz, REVIEW and EXPLAIN the correct answers.
  4. ANSWER any additional questions.

Click here for the FINAL QUIZ, followed by the ANSWER KEY WITH EXPLANATIONS. Hit your PRINT button while viewing the quiz to make a paper copy that you can duplicate and distribute to your students.

Final Quiz - Menstruation and Answer Key