From a pediatric perspective, a
risk assessment with regard to putting girls on oral birth control pills for
pre-menstrual and menstrual problems, involves a number of important factors,
the first of which includes the health, mental status and general well being of
the girls in question.
Another major concern must be
that of the age of the girls. At what age do girls begin to menstruate? This is
important because menstrual or pre-menstrual problems can begin, as soon as
young girls start to menstruate, but they do not necessarily start right away.
"On average, most girls
start their periods when they're 12 or 13 years old (although some begin
earlier or later)." (1)
This is a relatively
significant time in the lives of young girls, but also a time of serious
concern for their mothers, parents or guardians and doctors, as well as other
health care professionals, like school nurses.
"For a girl, getting her
first period is a physical milestone and a sign of becoming a woman. But it can
also be confusing and scary, particularly if she encounters certain problems
like irregular periods or premenstrual syndrome (PMS)." (2)
While referring to young girls, who have just begun to menstruate as women, one must remember these girls can
be very young. This is a time of transition for them. It is not always an easy
time for all young girls either, as many of them do not understand what
menstruation signifies; nor do they comprehend the reality of hormonal changes
in their bodies, as being instrumental in causing pre-menstrual or menstrual
problems.
Some of them do not realize that they could become pregnant, if they
engage in sexual activity.
What kinds of pre-menstrual or
menstrual problems do young girls experience, when they first begin to
menstruate?
Pre-menstrual and menstrual
problems can vary from girl to girl, as each one is a unique individual. In
other words, one girl may begin to menstruate at age eleven, while another girl
is already fifteen years old. The eleven year old who begins to menstruate may
have different kinds of problems than the older girl. The eleven year old may
experience only mild cramps when menstruating, while the older girl may
experience severe pre-menstrual symptoms of irritability, headaches and acne,
even though she has little cramping, when she menstruates.
Note that all young girls can
experience some pre-menstrual or menstrual problems. The degree or severity of
the symptoms can vary. This can include any of the following: "acne,
bloating, fatigue, backaches, sore breasts, headaches, constipation, diarrhea,
food cravings, depression or feeling blue, irritability, difficulty
concentrating, and (sic) difficulty handling stress." (3)
Women in their twenties,
thirties and early forties, can also experience the same kinds of pre-menstrual
and menstrual symptoms, related to hormonal changes or hormonal imbalance. Note
that there is a difference though, when it comes to the young girls who have
just begun to menstruate.
"Different girls may have
some or all of these symptoms in varying combinations. PMS is usually at its
worst during the 7 days before the period starts and disappears soon after it
begins. But girls usually don't develop symptoms associated with PMS until
several years after menstruation starts - if ever." (4)
Is it medically acceptable to
put all girls who experience pre-menstrual or menstrual problems on birth
control pills?
This is the point at which
proper physical examinations by doctors or gynecologists and appropriate
medical guidance or counseling becomes important for young girls. Other medical
problems may be discovered and need to be treated.
Birth control pills may not
necessarily be an appropriate treatment option for a girl age thirteen, who has
just begun to menstruate, even if she is experiencing some mild, pre-menstrual
or menstrual problems and has irregular periods.
A seventeen year old, who has
already become sexually active, may benefit from birth control pills, as they
will reduce her pre-menstrual symptoms, may help to regulate her periods and
probably be effective in terms of birth control. Birth control pills are no
guarantee that she will not get pregnant, even if they help to reduce the risk.
They will not reduce the risk of infection either, but may help her acne. In
time, she may complain to the doctor about breakthrough bleeding and decide not
to take her birth control pills. In the meantime, she is likely to miss pills
occasionally. Compliance is always a concern with teenage girls.
When doing a risk assessment on
young girls, one must decide whether the use of birth control pills is an
appropriate medical treatment option for all young girls, who have just begun to
menstruate and experience pre-menstrual or menstrual problems. Most medical
professionals will suggest that this is not a good idea.
Each individual case has risk
factors to consider, including areas of concern like a previous personal or
family history of blood clots or strokes.
Girls need to be aware that
what may prove to be effective as treatment for one teenager may not
necessarily be effective for others. Similarly, what appears to be effective
and appropriate treatment for their mothers may not necessarily be effective or
appropriate for them. Vice versa, this can be true as well.
For example, birth control pills might seem to be an
appropriate treatment for the mother of a fourteen year old. Both the mother
and daughter may be experiencing the same kinds of pre-menstrual and menstrual
problems. While the mother might approve of birth control pills for herself,
she may not approve of this option for her daughter. The doctor may not
recommend birth control pills for the daughter either.
Can one suggest that all women,
who are experiencing menstrual or pre-menstrual problems, need to receive
regular prescriptions for birth control pills? That is not the case, so why
would they be appropriate for all young girls?
Medicalization of menstruation
for all girls or women, regardless of age, is not necessarily the best answer.
In other words, resolving the medical problem with pills may not always be the
solution, depending upon the situation at hand.
Young girls, who have just
begun to menstruate, have a number of other possible options that they can and
should try first. Sometimes, it is up to the mothers of the girls or their
family doctors, to suggest alternative measures to them, rather than
immediately putting them on birth control pills.
Remember that any kind of birth
control pill can have serious short-term or long-term side effects. Birth
control pills are chemicals and using them is only one of many possible
treatment options for pre-menstrual or menstrual problems that occur in young
girls.
Young girls just entering into
womanhood often need some time to allow their bodies to adjust to the hormonal
changes that are taking place. This may not necessarily happen overnight.
Often young girls are fearful
about the physical and emotional changes associated with pre-menstruation and
menstruation. Counseling re sexual health and birth control are always
important, especially with young girls.
Mothers can be helpful and
effective with regard to teaching their daughters about menstruation. They know
from their own experience, how to deal with pre-menstrual or menstrual
problems. School nurses are instrumental in teaching young girls about
adjusting to their lives as women, through classes offered at schools or high
schools. More advanced education for older girls is available at colleges and
universities.
Mothers and daughters can talk
to registered nurses working in doctors' offices or walk-in clinics. There are
many books, cds, videos and dvds available for teaching or self-teaching
purposes. Any young girl can go to her doctor, if or when she is seeking
guidance or assistance with regard to menstruation or pre-menstrual problems,
as well as for birth control measures. She should be encouraged to do so, if
she is sexually active.
A physician may suggest to a
young girl, that it is a good idea to bring her mother into the doctor's
office, in order to discuss pre-menstrual or menstrual problems with her.
Effective measures for
pre-menstrual or menstrual problems may include the following: eating a
well-balanced diet that contains fresh fruits and vegetables, reduction of salt
intake to reduce water retention, reduction of caffeine to reduce anxiousness,
adding calcium rich foods, taking pain relievers like acetaminophen or
ibuprofen, taking a brisk walk, riding a bicycle, soaking in a warm bath or placing
a hot water bottle on the abdomen (5)
This is a word for mothers of
young girls who are experiencing menstrual problems.
"If you notice that your
daughter's usual periods are causing her great discomfort and interfering with
her life, talk to her doctor to make sure nothing else is causing the problem
and to see if anything can help.
Sometimes, hormone treatment, usually in the
form of birth control pills, can help ease many symptoms associated with
uncomfortable periods." (6)
In other words, the option of
putting young girls on birth control pills for pre-menstrual or menstrual
problems, particularly when they have just started to menstruate, should be a
last resort, not the first treatment option. But, it is an option.
1. http://kidshealth.org/parent/positive/talk/talk_about_menstruation.html?tracking=P_RelatedArticle
3. Ibid.
4. Ibid.
6. Ibid.
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