The conversations we do not have around menstruation cost girls years of unnecessary suffering. Here is everything that should be said — plainly, honestly, and without embarrassment.
By Dr. Neha Sain · Gynaecologist, MS (Obstetrics & Gynaecology)
I have been a gynaecologist for long enough to know that the most powerful thing I can do in this article is say clearly what should have been said earlier: menstruation is a normal physiological process, it is not shameful, it is not a secret, and every girl deserves to understand what is happening in her body before it happens — not after.
In India, a survey by the Dasra Foundation found that 70% of Indian girls are unaware of menstruation until they experience their first period. Many describe their first period as frightening. Some thought they were injured or dying. This is preventable. And it is prevented by information.
When does it start, and how will she know?
Menarche — the first period — most commonly occurs in Indian girls between the ages of 11 and 15, with the average around 12–13. It typically happens approximately two to two-and-a-half years after breast development begins, which is usually the first sign of puberty.
In the six to twelve months before the first period, most girls notice a change in vaginal discharge — a white or pale yellow fluid on their underwear that is not infection, not injury, and not anything to be alarmed about. This is the body's normal preparation for reproductive function, and seeing it is a useful signal that menstruation is approaching.
The first few periods are often irregular, light, and unpredictable. The body's hormonal system is establishing its rhythm, and this can take up to two years. Cycles that arrive every six weeks, or that skip two months, are normal in the first year or two. After two years, if periods remain very infrequent (fewer than eight per year), it is worth seeing a gynaecologist to check for conditions like PCOS.
What is actually happening
Each month — once the cycle is established — a hormonal signal from the brain causes one of the ovaries to mature and release an egg (ovulation). In preparation, the uterus builds a lining of blood vessels and tissue to receive a fertilised egg. When fertilisation does not occur, this lining sheds over the course of several days. That shedding is the period.
The blood comes from inside the uterus. It is not a sign of injury. Its colour, which ranges from bright red to dark brown to near-black, reflects how quickly or slowly it is moving through the body — darker blood has been inside longer; brighter blood is more recent. Both are normal.
The total volume of blood lost in a typical period is 30–80 millilitres — roughly three to eight tablespoons over four to seven days. This is not a large amount. Feeling lightheaded or dizzy during a period is worth mentioning to a doctor.
Period products: what is available and how to choose
Sanitary pads are the most widely used product among Indian girls and are the simplest to start with. They attach to the underwear and absorb blood externally. Change every four to six hours, and use a heavier or overnight pad on days with heavier flow. Wrap used pads in their wrapper or paper and dispose in a bin — they cannot be flushed.
Tampons are inserted into the vagina to absorb blood internally. There is a common misconception in India that tampons affect the hymen or that they are not suitable for unmarried girls. This is not correct. The hymen is a thin, elastic fold of tissue with a natural opening through which menstrual blood flows. A tampon does not remove the hymen and does not affect virginity. Tampons are safe for girls of any age who are comfortable using them. They should be changed every four to eight hours and should not be used overnight.
Menstrual cups are reusable silicone cups that collect blood internally. They are more economical and environmentally friendly than disposables. They require some practice to insert and remove correctly, but many young women find them highly practical once they are comfortable. They can be worn for up to twelve hours, including overnight.
Period underwear is absorbent underwear that can be washed and reused. It is excellent as a backup with a tampon or cup, or on lighter days. It is increasingly available in India.
Period pain: what is normal, and what is not
Mild cramping — a dull ache in the lower abdomen on the first one or two days — is common and is caused by prostaglandins, hormone-like chemicals that cause the uterine muscle to contract to expel the lining. This is manageable.
What is not normal, and what should always be taken to a doctor:
Pain severe enough to miss school or activities. Pain that is getting worse year on year. Pain that does not respond to ibuprofen taken at the correct dose. Pain during bowel movements during the period. Pain in the back, hips, or legs that accompanies period pain. These patterns can indicate endometriosis — a condition in which tissue similar to the uterine lining grows outside the uterus. Endometriosis is significantly more common than most people realise, and diagnosis is most valuable when it happens early, not after years of unnecessary suffering.
For ordinary period pain: ibuprofen (400mg with food) taken before the pain peaks — ideally starting the day before the expected period — works substantially better than waiting until the pain is severe. A heating pad or hot water bottle on the lower abdomen helps. Light exercise, counterintuitively, also reduces pain. Chamomile tea has mild anti-inflammatory properties.
Menstrual hygiene
The external genital area — the vulva — should be washed with water during the period. Mild, unperfumed soap may be used on the outer skin only. The vagina is self-cleaning and does not require washing internally. Vaginal douches, scented washes, and internal cleaning products are not recommended and can disrupt the natural bacterial balance, increasing the risk of infection.
Changing period products regularly — every four to six hours for pads, four to eight hours for tampons — reduces the risk of bacterial overgrowth and infection.
Swimming and exercise during periods are entirely safe. The idea that physical activity during menstruation is harmful is not supported by any medical evidence.
For parents: what a helpful conversation looks like
If your daughter is approaching puberty, have the conversation before menarche. Not a single, formal talk, but an ongoing, casual openness about the body. Answer questions directly without embarrassment. Stock the bathroom cabinet with pads before they are needed. Tell her that period pain that prevents normal functioning is not something to push through alone — that it deserves medical attention.
The goal is a daughter who is not frightened by her own body, who is not ashamed to ask for what she needs, and who knows that severe period pain is a medical symptom and not a personal weakness.
If you or your daughter has questions about menstrual health, cycle irregularity, or period pain that is not being adequately managed, I see patients through Smart Consultation. You can share the full picture and I will give you a clear, practical assessment.
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