Puberty in Girls: Physical Changes and Menstruation

Girls grow and develop (both mentally and physically) at different rates and ages. Ideally, you should begin introducing your daughter to her body, including her genitals, at an early age. Then, when it is time to talk about the sexual function of her body, it may not be as difficult. Use your judgment in determining when you daughter is ready for a conversation about puberty and menstruation. For many girls, this may be around age 8 to 10, keeping in mind that it may be earlier or later, depending on your child's development.

Whatever the age, it is important to find where to begin. Does your daughter know what it means to have a period? Use visuals such as drawings, pictures, or photos from a children's book, or use a hand held mirror to help find out if she can name her body parts and genitals and tell you the function of each part. When talking with her about these openings in her body, use the proper or real names of each instead of just saying "down there." Also teach her the slang terms for male and female body parts; she is likely to hear them at school or elsewhere.

Keep it SIMPLE: For example: "This is your urethra: this is where the urine/pee comes out when you use the toilet." "This is your anus: this is where the stool/ poop comes out after your food has been digested." "This is your vagina where blood comes out when you have your period."

Be POSITIVE and tell her that her body will grow taller, breasts will grow bigger, and hips will grow wider, and that it is NORMAL. Explain that it happens to all girls (including you) as they grow. She may be not be happy to hear that blood will come out of her vagina once a month, but reassure her that periods are normal, healthy, and a sign that she is growing to become a woman.

Keep it PRIVATE: Talk to her about privacy. Talk to her about appropriate places to change her clothes and her pads and where and to whom it is appropriate to discuss her period. A good way to open the conversation is through books and materials that discuss puberty and sexual topics in a frank and straightforward manner. The end of this article offers several suggestions.

• Consider using picture books or a body puzzle to make a simple game such as "find the body part" to see if your daughter understands what the body parts are and their functions; give her a healthy reward or praise to show her that she has done well.
• Read books together about puberty/adolescence, OR if your daughter doesn't want to read with you, make them available to her by placing them in places wheres she plays.

Getting Ready for Her Period

Prepare your daughter for getting her period before she gets it. It may make her nervous about getting her period at first, but understanding what is happening when they get their period is better for most girls on the autism spectrum.

You will need to help prepare your daughter for the physical, emotional, and logistical issues that accompany having her period. Often starting with logistical concerns is easiest. Then you can move on to the physical and emotional components.

• Does your daughter routinely carry a handbag or backpack around with her? If not, you may want to get her accustomed to doing so. Let her pick out a bag of her choice.
• Take your daughter shopping to buy supplies (prior to actually needing them). Walk down the feminine supply aisle so she can become familiar with where supplies are located and the different brands, styles, sizes, and scents available. Consider using sanitary napkins without wings (fewer steps for securing pad).
• Before your daughter gets her period, consider having her carry feminine supplies in her handbag or backpack and practice keeping them out of sight. Prepare a "period kit" with menstrual supplies, an extra set of panties (in case of accidents), and a plastic bag.
• Consider having your daughter watch you (her Mom) or a sister change a sanitary pad.
• Place a few drops of red food coloring on a pad to demonstrate what blood will look like when your daughter has her period.
• Let your daughter get used to what it feels like to wear a pad. Have her wear a panty liner or mini-pad an hour or more each day to adjust to the sensation of wearing a pad and gradually work up to wearing a pad more appropriate for a heavy period day.

Another way you can help your daughter learn about how to manage her period is to make a "My Self Care" booklet. The booklet can be a reference for her to refer to before she gets her period each month. Below are ideas to consider when making your daughter's personalized booklet:

• List supplies with matching photos of pads wrapped up (of different sizes); show the pads in the box you purchase them in, wrapped, and unwrapped.
• Show a pair of clean panties and a pair that has stains from menstrual flow.
• Cut out pictures or drawings from books or websites (see references at end for links).
• Create a Social Story™ with pictures or create and laminate a picture schedule with steps and pictures in order of occurrence:

1. A picture of a clean panties
2. Photo of clean pad
3. Picture removing the adhesive strip from the pad
4. Photo of placement of the pad in the panties
5. Photos of soiled pads (use red food coloring) showing spotting (light and heavy flows)
6. Photo to show her how to roll up the pad in toilet paper after use
7. Photo placing used pad in the trash (rather than toilet)
8. Photo of your daughter washing her hands with soap and water

Set a schedule with your daughter for how often she should change her pad to avoid accidents. But also let her know that accidents happen to all women. Prepare your daughter that blood may get on her panties. Place an extra pair of panties in her period kit to change into. Put a plastic bag in the kit for bringing soiled panties home for laundering.

If your daughter has difficulty using her hands and completing more than one or two steps in order, try this method when teaching her placement of the pad:

• Backward Chaining: Begin with the last step in the process. For example, have her start by taking the soiled pad (already rolled up in toilet paper) and place it in the garbage, followed by washing her hands. Have her complete that task several times then go back just one step: have her roll the soiled pad and then place it in the garbage and wash her hands; next, have her take the soiled pad off of her panties, roll it up and place it in toilet paper, place it in the garbage, and finish with washing her hands. This way she practices each step one at a time several times and adds on one step at a time until she can complete the sequence on her own from beginning to end. Be positive and praise her each time she completes a step.

Once Menstruation Begins

• Teach your daughter to mark a calendar with "P" or some other abbreviation to help remind her when she started her period each month. This will help her predict when next month's period will begin.
• In the beginning, it may not be easy to predict when your daughter will begin menstruating each month and how long it will last. To avoid surprises, she may want to begin wearing a mini pad about seven days before her period is due. She can wear a panty liner for a day or two after you/she thinks her period is finished. Tell her that if she has two days in a row where there is no more blood, her period is probably finished.
• Once your daughter begins menstruating, she will sometimes have her period while at school. Be sure your daughter's teacher and the school nurse know and have a plan to support your daughter in school when she is having her period. It is important that the team responds similarly and supportively. Your daughter should know who to go to with questions or problems while at school, perhaps the school nurse or her teacher or aide.
• Make sure your daughter is prepared while at school:
  • Provide a supply of different thickness pads for light through heavy flows to keep in your daughter's school locker.
  • Set a schedule for pad changes (every 2-3 hours). Help make this concrete by adding this to your daughter's schedule or by programming a reminder into her phone or iPad® (if she is allowed to use these at school). Make sure the reminders you set are known to your daughter but not obvious to anyone else who might see them.
  • Consider letting your daughter use overnight pads (which are longer and thicker) if you think she will have difficulty with the placement of the pad while on her own at school or if she may have trouble remembering to change frequently. (These may be more uncomfortable, however.)
• Depending on your daughter's skill level and readiness, she may want to advance to using tampons. Make sure your daughter understands the importance of changing tampons regularly and of making sure to remove one before inserting another.
• There are a wide variety of birth control methods that can influence monthly menstrual cycles. These include pills, injections, and implants that should be discussed with a gynecologist who knows your daughter and understands her ability and disability. Some things to consider are:
  • Predictability
  • Control of length and flow
  • Frequency of menstruation
  • Discomfort for the young woman
  • Pregnancy prevention
• Most certainly, a gynecologist needs to be on your "team" to help with these most important and sensitive issues.

Emotional Changes and Menstrual Cramps

Just like most girls, your daughter may feel and act grumpy, tired, anxious, or have "melt downs" several days to a week before her period begins. Prepare her for this. Look for mood changes and depending on her level of understanding, reassure her and help her to understand that what she is feeling at this time is normal. Tailor your discussion according to her verbal ability and level of understanding. If she appears moody, is acting out, or having melt downs, try getting her to take a brisk/fast walk with you or another physical activity. Offer her healthy snacks and fruits and vegetables. Stay away from salty foods such as pretzels and chips to cut down on bloating, and encourage her to drink water. A warm bath or hot water bottle on her belly may help with cramps. If she complains of head, belly, or back pain that does not go away after a day or two or pain that prevents her from going to school and activities, consider over the counter pain preparations and/or ask her doctor about pain medication. If the doctor approves, have a supply of pain relief medications at home such as Ibuprofen (Advil) or Naproxen Sodium (Aleve). Take with food or after eating to avoid stomach upset. These products tend to be more effective than Acetaminophen (Tylenol) for cramps.

Additional Resources

• When Your Special Needs Daughter Gets Her Period

Additional Reading

The Care & Keeping of You: The Body Book for Girls by Valerie Lee Schaefer; Demco Media, 1998. This "American Girl" book has information to help teach girls about growing up, having their periods, and changes to their bodies. Included is a discussion about using tampons and pads, choosing a bra, shaving, etc. There is a discussion of sleep issues and advice from other girls on pimples, exercising, and eating disorders.

Girls Growing up on the Autism Spectrum: What Parents and Professionals Should Know About the Pre-Teen and Teenage Years by Shana Nichols; Jessica Kingsley Publishers Ltd., 2008. This book addresses the concerns commonly faced by girls on the autism spectrum and their parents, from periods and puberty to worries over friendships and "fitting in." Also covered are issues of cognition, communication, behavior, sensory sensitivities, and social difficulties.

Personal Hygiene? What's that Got to Do with Me? by Pat Crissey; Jessica Kingsley Publishers Ltd., 2005. This book was developed for individuals on the autism spectrum and/or with other learning and developmental disabilities to help them understand how others perceive their appearance and the social implications of neglecting personal hygiene. There are quizzes and hands-on activities to demonstrate why and how to perform various hygiene tasks.

Taking Care of Myself, A Hygiene, Puberty, and Personal Curriculum for Young People with Autism by Mary Wrobel; Future Horizons, 2003. Written by a teacher/speech-language pathologist, the book uses simple stories to demonstrate what to say and not to say when talking to your child about hygiene and puberty. The book addresses hygiene, modesty, body growth and development, menstruation, touching, personal safety, and more.

What's Happening to My Body: A Book for Girls by Lynda Madaras, Area Madaras, Simon Sullivan; Newmarket Press, 2007. This straightforward book discusses physical body changes, the menstrual cycle, diet and exercise, sexual feelings, and sexually transmitted diseases.

The Underground Guide to Teenage Sexuality by Michael J. Basso; Fairview Press, 2003 (2d Ed). Written by a sex educator, this book is for teenagers. It provides accurate and objective information about sexuality to help teens understand their changing bodies and make informed decisions about sexual activity.