Menstrual Health: Tampons and menstrual hygiene products

Menstruation is a major event in the progression of puberty for young women. There are a number of menstrual hygiene products available. The most commonly used products are tampons and pads. However, lesser known products include the menstrual cup, padded panties, reusable menstrual pads, sea sponges, and the miniform. Each product has advantages and disadvantages. The menstrual cup, padded panties, and reusable menstrual pads tend to be more economical and ecologically friendly choices. Pads, tampons, and miniforms are disposable options. Some products are placed inside the vagina, such as the tampon, menstrual cup, and sea sponge, whereas pads, padded panties, and the miniform are all used outside the vagina. Physicians historically have avoided discussion of menstrual hygiene products during female adolescent visits. It is important for healthcare providers to be knowledgeable about the proper use of menstrual hygiene products due to the risk of toxic shock syndrome as well as other health risks. It is also extremely important for healthcare providers to be able to fully inform teens of risks, benefits, and proper use of products. Traditional teaching indicates that the first menstrual period should begin by age 16 years, and that early menstrual cycles are irregular and anovulatory for at least the first 2 years. While it is true that early menstrual cycles are somewhat irregular, and many early cycles are anovulatory, epidemiologic evidence indicates that there are evidence-based parameters that should guide clinical care. The normal age of menarche, parameters for menstrual cyclicity, duration of menstrual bleeding, and amount of bleeding should be communicated to teens and their parents in an effort to evaluate, manage, or prevent menstrual morbidities. Evidence indicates that the first menstrual period (menarche) should occur by the age of 15 years, menstrual cycles may vary from approximately 20 to 45 days, bleeding should last a week or less, and bleeding requiring a change of soaked pads more frequently than hourly is associated with anemia. Menstrual suppression, the use of hormones to delay or eliminate menses, has become increasingly common among young women. Adolescents often desire less frequent menstruation than monthly. Also, many medical conditions commonly experienced by young women, including menorrhagia, dysmenorrhea, pelvic pain, and migraines, can improve with menstrual suppression. The frequency of menstruation can be decreased with a number of different hormonal contraceptive regimens, each associated with different risks, benefits, side effect profiles, and rates of amenorrhea. This chapter reviews the different modalities for menstrual suppression, common conditions in which adolescents may benefit from less frequent menses, and strategies for managing breakthrough bleeding.