Menstruation

by

Ingrid Johnston-Robledo, Margaret L. Stubbs, Ashley Walch

• LAST REVIEWED: 28 May 2013
• LAST MODIFIED: 28 May 2013
• DOI: 10.1093/obo/9780199791231-0130

Introduction

The topic of menstruation related to childhood includes a vast literature. This bibliography includes works representing the range of associated topics, including references to important early and current research, as well as material available to lay audiences (e.g., documentaries, websites, and books). The biology of menstruation, including emphasis on regular menstruation as an important sign of health, is foundational to understanding the topics that follow. Pubertal timing focuses on a decrease in the age of pubertal onset in the United States and worldwide and related implications for healthy development. The reader is cautioned to determine how researchers are defining “early puberty” and to remember that menarche is a late event in the process and not a marker of onset. That said, the impact of early menarche on girls’ development, broadly considered, is important in its own right. Researchers have studied about what might trigger early menarche, and also specific (mostly negative) outcomes of early menarche, toward interventions that might target these girls for more support. Material informing readers about the cultural representation of menstruation (e.g., as taboo—both polluting and awe-inspiring) sheds light on the social factors influencing girls’ experiences of menstruation. Related is communication about menstruation, including themes of concealment and secrecy, but also creative ways that girls talk about menstrual experience. A focus on how girls actually experience menstruation begins with references about how menstrual experience is assessed, including refinements to early measures that now permit broader investigations. Information about girls’ attitudes and beliefs related to cultural context are presented next, followed by results from investigations of actual menstrual experience. Information from two populations, retrospective accounts from older females and those of early adolescent girls themselves is presented. Embodiment related to menstruation, e.g., how menstruation influences girls’ body image, developing sexuality, and related self-care (e.g., contraceptive use) is an aspect of menstrual experience that is too often neglected by parents and others working with girls. Information about girls’ knowledge of menstruation suggests that they are not well informed. Specificity about effective preparation is also found wanting. More research attention, adult scrutiny, and improvement is needed in efforts to prepare girls for more positive menstrual experience, including the provision of accurate and relevant content from various sources of information. Finally, references from a specialized literature on common menstrual complications, menstruation related to other health issues, and the experiences of disabled teens conclude the bibliography.

The Biology of Menstruation

Menstruation is a complex, biological event within pubertal development, which is a process that takes place over time and includes other physical changes. Marshall and Tanner 1969 describes the Tanner stages of pubertal development in general. These have been and are still used by many researchers who wish to investigate and compare both girls and boys at various stages of pubertal development. Among the pubertal markers used in the Tanner stages are pubic hair and breast development for girls. Referring to the criteria set for the development of these markers during puberty, researchers can categorize study participants, for example, as early, on-time (average), or late maturers. Menarche, or first menstruation, is a later event within girls’ pubertal development. Although we do not yet fully understand the mechanisms that determine when menarche will occur, Frisch 1983 was instrumental in identifying body composition as an important factor in both the beginning and continuation of regular menstruation. Building on this early work, researchers have continued to refine investigations into body composition especially in relation to a secular trend of earlier pubertal development (see Pubertal Timing). Readers interested in a more technical explanation of the physiological processes involved in menarche and pubertal development can consult DiVall and Radovick 2008. They discuss how various factors, both biological (genes) and environment (nutrition) may combine to trigger pubertal onset and menarche. Hillard 2008 is about the important role of physicians and gynecologists in helping girls and parents adjust to daughters’ maturing bodies. She urges an initial well-visit screening for girls aged thirteen to fifteen in which health-care practitioners can provide important information about normal early menstruation, obtain an in-depth menstrual history, and check for any signs of early menstrual dysfunction among girls who may have already begun to menstruate. Her very clear explanation of the physiology of normative early menstruation and, on the other hand, what alterations from this norm imply for girls’ long-term reproductive health will also be valuable and accessible to lay readers. The final paper in this section is American Academy of Pediatrics 2006, which encourages a conceptualization of regular menstruation as a vital sign of health for girls. In it, clinicians are urged to take seriously irregular menstruation among young adolescent girls since overlooking this signal of potential ill-health can lead to serious reproductive problems later in life.

• American Academy of Pediatrics. “Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign.” Pediatrics 118 (2006): 2245–2250.

  DOI: 10.1542/peds.2006-2481

  Argues that regular menstruation is a sign of health in young girls and that irregular patterns of menstruation should not be seen as normative but instead taken seriously by health-care practitioners to permit early detection of related health concerns in adulthood.

• DiVall, Sara A., and Sally Radovick. “Pubertal Development and Menarche Annual of the New York Academy of Science.” Annual of the New York Academy of Science 1135 (2008): 19–28.

  DOI: 10.1196/annals.1429.026

  This more technical article describes the physiological processes underlying menarche as well as how other factors, such as neurotransmitters, neuropeptides, metabolic factors, and genetics influence these processes.

• Frisch, Rose E. “Fatness, Puberty, and Fertility.” In Menarche. Edited by Sharon Golub, 5–20. Lexington, MA: Lexington Books, 1983.

  In this classic article, Frisch explains the relationship between body composition (fat-to-muscle ratio, taking height into account) and the onset and continuation of regular menses. Too little or too much fat is related to amenorrhea. This work is foundational to understanding the physiology of menstruation.

• Hillard, Paula J. A. “Menstruation in Adolescents: What’s Normal, What’s Not.” Annals of the New York Academy of Sciences 1135.1 (2008): 29–35.

  DOI: 10.1196/annals.1429.022

  Hillard presents a clear overview of normative menstruation with advice for clinicians about how to obtain an effective menstrual history from mothers and/or adolescent clients, what diagnostic tests should be conducted if menstrual dysfunction should be detected, and how to help parents talk with daughters about maturation and sexuality. Parents will also find this article accessible and informative.

• Marshall, W. A., and J. M. Tanner. “Variations in the Pattern of Pubertal Changes in Girls.” Archives of Disease in Childhood 44 (1969): 291–303.

  DOI: 10.1136/adc.44.235.291

  In this classic paper the authors provide a description of how to judge pubertal development in girls with reference to breast size and shape and the distribution of public hair. The Tanner stages continue to be used by contemporary researchers of girls’ pubertal growth and status.