1. Menstrual disturbances

2. Cramps:
-Many girls experience abdominal cramps during the first few days of their periods. They're caused by prostaglandin, a chemical in the body that makes the smooth muscle in the uterus contract. These involuntary contractions can be either dull or sharp and intense.
-The good news is that cramps usually only last a few days. But call your daughter's doctor if she has severe cramps that keep her home from school or from doing stuff with her friends.

3. -It can take 2 to 3 years from a girl's first period for her body to develop a regular cycle. During that time, the body is essentially adjusting to the influx of hormones unleashed by puberty. And what's "regular" varies from person to person. The typical cycle of an adult female is 28 days, although some are as short as 21 days and others are as long as 45.

4. -Changing hormone levels might make a girl's period last a short time during one month (just a few days) and a long time the next (up to a week). She may skip months, get two periods almost right after each other, or alternate between heavy and light bleeding from one month to another.
-But any girl who's sexually active and skips a period should see a doctor to make sure she's not pregnant.

5. And if your daughter's period still hasn't settled into a relatively predictable pattern after 3 years, or if she has four or five regular periods and then skips her period or becomes irregular, make an appointment with her doctor to check for possible problems. Also let your daughter's doctor know if her cycle is less than 21 days or more than 45 days, or if she doesn't get a period for 3 months at any time after first beginning to menstruate.

6. Delayed Menarche
-Girls go through puberty at different rates. Some reach menarche (the medical term for the first period or the beginning of menstruation) as early as 9 or 10 years old and others don't have their first periods until they're well into their teen years. So, if your daughter is a "late bloomer," it doesn't necessarily mean there's something wrong with her.

7. -When girls get their periods actually depends a lot on genetics
-When girls get their periods actually depends a lot on genetics. Girls often start menstruating at approximately the same age their mothers or grandmothers did. Also, certain ethnic groups, on average, go through puberty earlier than others. For instance, African-American girls, on average, start puberty and get their periods before Caucasian girls do.

9. -Although most period problems are harmless, a few conditions can be more serious and require medical attention:

10. Amenorrhea (the Absence of Periods)
Girls who haven't started their periods by the time they're 16 years old or 3 years after they've shown the first signs of puberty have primary amenorrhea, which is usually caused by a genetic abnormality, a hormone imbalance, or a structural problem. Hormones are also often responsible for secondary amenorrhea, which is when a girl who had normal periods suddenly stops menstruating for more than 6 months or three of her usual cycles.

11. -Since pregnancy is the most common cause of secondary amenorrhea, it should always be ruled out when a girl skips periods. In addition to hormone imbalances, other things that can cause both primary and secondary amenorrhea include:

12. stress
significant weight loss or gain
anorexia (amenorrhea can be a sign that a girl is losing too much weight and may have anorexia)
stopping birth control pills
thyroid conditions
ovarian cysts
other conditions that can affect hormone levels

13. Something that can also cause primary and secondary amenorrhea is excessive exercising (often distance running ) combined with a poor diet, which usually results in inappropriate weight loss or failure to gain weight during growth. But this doesn't include the usual gym class or school sports team, even those that practice often. To exercise so much that she delays her period, a girl would have to train vigorously for several hours a day, most days of the week, and not get enough calories, vitamins, and minerals.

14. Menorrhagia: (Extremely Heavy, Prolonged Periods)
-It's normal for a girl's period to be heavier on some days than others. But signs of menorrhagia (excessively heavy or long periods) can include soaking through at least one sanitary(pad) an hour for several hours in a row or periods that last longer than 7 days. Girls with menorrhagia sometimes stay home from school or social functions because they're worried they won't be able to control the bleeding in public.

15. -The most frequent cause of menorrhagia is an imbalance between the levels of estrogen and progesterone in the body, which allows the endometrium (the lining of the uterus) to keep building up. When the endometrium is finally shed during menstruation, the resulting bleeding is particularly heavy.
-Because many adolescents have slight hormone imbalances during puberty, menorrhagia isn't uncommon in teens. But in some cases, heavy menstrual bleeding can be caused by problems such as:

16. fibroids (benign growths) or polyps in the uterus
thyroid conditions
clotting disorders
inflammation or infection in the vagina or cervix
-If your daughter has heavy periods, or periods that last longer than 7 days, talk to her doctor

17. Dysmenorrhea (Painful Periods)
-There are two types of dysmenorrhea, which is severely painful menstruation that can interfere with a girl's ability to attend school, study, or sleep:

18. Primary dysmenorrheal:
- is very common in teens and is not caused by a disease or other condition. Instead, the culprit is prostaglandin, the same chemical behind cramps. Large amounts of prostaglandin can lead to nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. Fortunately, these symptoms usually last for only a day or two.

20. Secondary dysmenorrhea :
-is pain caused by some physical condition like polyps or fibroids in the uterus, endometriosis, pelvic, or adenomyosis (uterine tissue growing into the muscular wall of the uterus).

21. Treating Menstrual Problems;
-To determine whether a problem requires treatment, The doctor may do a pelvic exam, a Pap smear, blood tests (to check hormone levels), or urine tests. If there might be a structural problem or some sort of growth, an ultrasound or CT scan may be performed. Together, these tests can help the doctor determine how a condition should be handled.

22. -Growths such as polyps or fibroids can often be removed and endometriosis can often be treated with medications or surgery. If a hormone imbalance is to blame, the doctor will likely suggest hormone therapy with birth control pills or other hormone-containing medications.
for menstrual pain with no underlying medical cause, anti-inflammatory medicines are the most effective treatment. Conditions like clotting disorders or thyroid problems may require treatment with medications as well.

23. When to Call the Doctor?
If the period hasn't started at the expected time for example if she's 15 or her period hasn't become regular after 3 years of menstruating. The most likely cause is a hormone imbalance (which may need treatment), but this also might point to another medical problem. The midwife need to take good history for the following conditions

24. If the woman stops getting the period or it becomes irregular after it has been regular. If the cycle is less than 21 days or more than 45 days, or if a period for 3 months stopped at any time after first beginning to menstruate.
If the woman has heavy or long periods, significant blood loss can cause iron-deficiency anemia. Also, heavy bleeding could be a sign of a growth in the uterus, a thyroid condition, an infection, or a blood clotting problem.

25. is very painful periods
is very painful periods. Having cramps for a couple of days is normal, but if the woman isn't able to participate in her normal activities, let the doctor know. She might have a medical problem, such as endometriosis, causing the pain.

26. Things help during the PMS
-When the woman experiencing a particularly bad PMS or cramps, you can help make her to feel more comfortable by suggest that she:

27. eat a balanced diet with lots of fresh fruit and vegetables
reduce her intake of salt (which can cause water retention) and caffeine (which can make her jumpy and anxious)
include foods with calcium, which may reduce the severity of her PMS symptoms
try over-the-counter pain relievers like acetaminophen or ibuprofen for cramps, headaches, or back pain
take a brisk walk or bike ride to relieve stress and aches
soak in a warm bath or put a hot water bottle on her abdomen, which may help her relax