AS the mother of a 9-year-old girl, I have already started speaking to my daughter about menstruation and how she should care for herself once she has her period.
When I was growing up, menstruation was not discussed openly. It was shrouded in secrecy, sanitary pads kept hidden away and girls grew up with all sorts of misconceptions about what is, in fact, a natural process.
In Asian society, menstruation is unfortunately linked to myths and taboos, and menstruating women are sometimes viewed as "unclean".
In some cultures, these women are kept isolated from the rest of the household, not allowed to enter the kitchen or prepare meals.
Others believe that menstruating women should not go out of the house.
Consultant obstetrician and gynaecologist and maternal medicine specialist at Prince Court Medical Centre Dr Shilpa Nambiar says it is unfortunate that Asians still talk about periods as being "unclean".
A century ago, hygiene may have been an issue, she explains. Sanitary napkins needed to be washed and blood increased the risk of infection, so it made sense for a girl not to go out.
But today, those concepts are outdated. Women have much better personal hygiene and access to disposable pads, tampons and menstrual cups, which means they should not be discriminated against.
Dr Shilpa adds that it's good that the current generation of parents no longer view menstruation as taboo.
"I have seen a change in attitudes especially in the urban population, however, in rural communities, this is not as apparent so that's where we need to concentrate our efforts."
THE RIGHT AGE
The average age of menstruation among girls in Malaysia is 12. It was 17 in the 1800s.
Dr Shilpa says this probably is a reflection of better nutrition and girls becoming taller than their ancestors.
She adds that there are many factors associated with an earlier menarche (the first menstruation), including biology, genetics and environmental factors.
Achieving a certain body weight is a prerequisite for puberty to start. The biggest factor in getting periods early seems to be better nutrition. Girls today are taller and better developed at earlier ages. However, a concerning trend is when this development is due to obesity.
"Fatter children are not necessarily healthier children and this is due to bad childhood nutrition. There are also girls who have problems with periods and subsequently develop other metabolic and health issues." says Dr Shilpa.
Getting their period too early (under the age of 8) or what is called "precocious puberty" may be a sign that there are other medical problems that need to be investigated.
Some of these causes are dangerous, like having a tumour or fluid build-up and infection in the brain. It can also be a sign of other hormonal abnormalities.
LET'S TALK
Dr Shilpa says it is never too early to start a conversation with girls about menstruation but it depends on the ability of the child to understand.
Generally, they should be taught that boys and girls are physically different by the time they are in preschool and when they are 7 or 8, the more complex concepts of internal organs can be introduced through pictures to explain the process.
Dr Shilpa explains that between one and two years after the first period, it may be normal if it isn't completely regular or on time every month. Most girls grow into it and their cycles settle into a predictable pattern.
Having some cramps on the first day and premenstrual symptoms like tummy bloating, breast tenderness and mood spells can also be normal and may vary from individual to individual.
However, if any of these symptoms are extreme or if they interfere with a girl's ability to function normally or cause absences from school, investigation is needed.
"If the menstrual cycles are so erratic that she sometimes goes months without a period or is starting to develop other symptoms like sudden weight fluctuations, abnormal facial hair growth or acne, she needs to see a doctor to assess if there is an underlying hormonal problem," says Dr Shilpa.
Bleeding very heavily may also indicate a problem, especially if it's causing the girl to be tired and fatigued or even anaemic.
When it comes to menstrual hygiene products, preference should guide one's choice.
If a girl is responsible enough to change her pads or tampons before they soil her clothes and ensure they are disposed of responsibly, there should be no issue.
Cloth napkins, which are getting increasingly popular these days, are also fine, adds Dr Shilpa, as long as they are changed and washed.
The more environmentally conscious women are now using silicon menstrual cups that are inserted into the vagina to collect blood and can be emptied and reused, while tampons are good for women who go swimming or exercise.
However, there is a danger if tampons are left in for more than eight to 10 hours as the infection risk rises, warns Dr Shilpa.
"The important thing is to change them and keep the perineum clean. The frequency of changing pad or tampon depends on how quickly it gets soaked."
Heavier days may require changes every two to three hours, but this also depends on the absorbency of the pad or tampon.
The principle is to prevent overflow, soiling of clothes, and infection from leaving a tampon in for more than 12 hours.
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