Why is it that teenage girls are often prescribed the pill to “fix” hormonal problems? During puberty, our periods are often not normal, which is completely normal! This is because the hormonal pathways are just starting to develop. On average, for teens 12 and under, it takes 5 years for hormones to balance to “normal” levels. The later the onset of menstruation, the longer it takes for regular cycles to settle in.(1) Teenagers might notice irregular cycles, anovulatory cycles, and symptoms of hormonal imbalance. But because we are in a culture of quick fixes, we would rather easily solve the problem then either deal with being uncomfortable for a little while, or solving the root cause of the issue. Both which take longer than the immediate “fix” of going on the pill.
But does the pill really fix period issues for teenagers AND menstruators after puberty? Not really. The symptoms will likely subside while you are on the pill, but this doesn’t mean they are fixed. Simply, your natural hormone production is quieted. This means that once you come off the pill, especially if you had menstrual issues before, they will come right back. Your body will have to re-learn how to produce its own hormones, as well as how to ovulate again. Another thing to keep in mind is the side effects that come with the pill (2).
In 2015, the American College of Obstetricians and Gynecologists released a study stating the: “identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood” (3). Masking symptoms with hormonal birth control, means you also miss out on potential red flags for hormonal issues later on in life.Knowing how your hormones and fertility work, means you can make informed contraceptive choices. And this is true for menstruators of any age!
For teenagers who might be navigating sex and contraceptives for the first time, they might benefit from learning about how their cycle works beyond menstruation.
Fertility is not just for babies and our fertility and hormones dictate more than just reproduction. For example, without ovulation, our bodies would not produce progesterone, which is associated with mood and sleep. Hormonal contraceptives work by impacting ovulation and fertility in some way.Another 2018 study found that combined hormonal contraceptives (the pill), decrease bone density in adolescents (4). We need regular ovulation and our own natural hormones for overall health, not just reproductive health. When we understand that we are only fertile for a small portion of the month, yet we are taking medications that completely shut down ovulation, it starts to make less sense. At the same time, I don’t believe that all teenagers have the capacity to learn FAM and take the responsibility of charting, working with an instructor, making choices for when you can/can’t have unprotected sex.
Teens can have knowledge on how contraceptives work and make a choice that fits best for them.
They can also be encouraged to use condoms as an effective birth control method, and they can be affirmed that they’re not irresponsible if they aren’t on a form of hormonal birth control, just that they’re using some kind of protection. They could even learn that on their most visibly fertile days (when they have eggwhite mucous) they could double up on barrier methods.For teens who aren’t sexually active, they can still benefit from learning about their cycle beyond menstruation. I wonder, do you remember your sex ed? Or “Family Life” when I was in elementary school. The boys and girls would be split up, and lord only knows what the boys were being told, but the girls were being taught about body odor and menstruation.
If I could talk to my grade 7 self, I’d tell her a lot more than about menstruation. I’d tell her about the phases of her cycle, the challenges and benefits of each phase, about her contraceptive options beyond the pill, and about the purpose of cervical fluid. I recommend the book Cycle Savvy by Toni Weschler, for teens and their caregivers. It is an excellent resource! You can find it here.I start conversations with the young people in my life, as well as talk to caregivers of teenagers. These are some of the things I have taught teen girls, and perhaps you can try some of them as well:
Teach her about cervical fluid. Let her know that it isn't shameful. Its necessary for keeping sperm alive, if she would one day like to get pregnant.
Print her a basic moon mapping/cycle mapping chart, where she can mark her mood for each day of the cycle
Teach her about ovulation. Tell her that something happens each month that most people don't know about. She can actually listen to her body to find out when an egg is released by monitoring cervical fluid.
Tell her that the ebb and flow of her cycle is normal and a gift. Teach her about the 4 phases of the cycle, and how they are impacted by hormones.
Let her know that her body will give her messages, and encourage her by modeling to listen to her body when it is asking her to slow down. Let her know that her cycles will also give her messages. Things like a delayed period, cramps, moodiness, can all be signs that our cycles are begging us to listen.
Don't be afraid to talk about sex! Let's raise a generation of girls who are empowered to make choices that feel good for them, and to know that they won't be shamed for those choices. Foster a sex-positive language and narrative around sex. Talk about how they will know if they're ready for sex, respond lovingly and without judgement, and be the person to bring it up first.
The response has been a deeper, trusting relationship between us. Teens have less fears around the symptoms of her cycle, and more trust, and even MORE questions, which we can welcome with calm, informed, non-judgmental responses.I encourage you to have a conversation with your teen. Having the courage to open the conversation can feel scary, but it tells the young one in your life that you are a safe person to talk to.
.2 https://www.sciencedirect.com/science/article/pii/S00107824060036353 https://www.ncbi.nlm.nih.gov/pubmed/265955864 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016495/