Young Women’s Health

Adolescence

Adolescence is a period of transition from childhood to teenage girlhood. During this period, physical development and personality development are very rapid. This development starts at the age of 9-10 in girls and continues until the age of 18. During puberty, when the changes necessary to become a healthy woman take place, the brain and reproductive organs send messages to other parts of the body through chemicals called hormones. Girls go through puberty about two years earlier than boys. This process of growth and development cannot be regulated by the individual. This process only starts when the body is ready.

Changes in your appearance;

With the onset of puberty, the buttocks become rounder, followed by the appearance of hair around the genitals and in the armpits. The size and shape of the breasts change. These changes can be fast or slow depending on the individual. More sweating starts, especially in the armpits. During this period, skin oiliness increases and pimples appear due to the effect of hormones. Menstrual bleeding and menstrual cycles begin with the effect of sexual hormones that start to be released more from puberty. With the effect of hormones, emotions and behaviors change, the psychological structure will change from the personality of a child to that of a young girl.

Internal and External Genital Organs

The reproductive organs consist of internal and external genitalia. Reproductive and sexual functions take place in these organs under the control of chemical signals from the brain.

External Genital Organs:

The external genitalia consist of the inner and outer labia called the vulva, the clitoris, the hymen and various glands. The inner and outer labia, which surround the opening of the vagina, are folds of skin containing fatty tissue, sweat glands and hair follicles. The vulva protects the entrance to the vagina and the urethra (urinary opening) from external influences. The clitoris is the female remnant of the structure that forms the penis in men. The hymen (hymen) is a thin membrane that covers the entrance to the vagina. Menstrual blood flows out through the hole between the edges of this membrane.

Internal Genital Organs:

The internal genital organs consist of the vagina, cervix, uterus, fallopian tubes and ovary.

The vagina is a structure made up of muscles that extends from the vulva to the uterus.

The cervix (cervix) is the narrowed end of the uterus. It provides the connection between the vagina and the uterus. The opening in the cervix allows menstruation to pass through. The uterus is separated from the vagina by the cervix.

The fallopian tubes (oviducts) are the tubes that run between the uterus and the ovaries. It is in these tubes that the egg released from the ovaries is fertilized. The fertilized egg passes through the tubes and reaches the uterus.

The ovaries are walnut-sized structures located on either side of the uterus. One egg matures and is released from the ovaries, which secrete female hormones, every month from puberty until menopause.

Menstrual Cycle

During puberty, stimuli from the brain cause the ovaries to release hormones called estrogen and progesterone. The menstrual cycle is regulated by these hormones. When a girl is born, there are around 400,000 eggs in her ovaries. From birth until puberty, some of the eggs degenerate. With puberty, one egg matures and is released each month. The first menstruation is called menarche. Menstruation starts between the ages of 9 and 16.

Day 1-14; These days are also called the estrogen phase of the cycle. Estrogen is at its lowest level on the first day of menstruation. With the signals sent from the pituitary gland, a hormone called FSH is released, this hormone stimulates estrogen production from the ovaries.

DAY 1; Menstrual bleeding begins. Although the amount is not important, the first day of bleeding is counted as the 1st day of the cycle. Bleeding is usually seen every 28 days. In this period, if the egg released from the ovaries from the ovaries is not fertilized, it is discarded together with the inner layer of the uterus. The first day of menstrual bleeding may be painful.

2-5 DAYS; Bleeding gradually decreases.

DAY 6; Bleeding stops, meanwhile the egg in the sac called follicle continues to grow in the ovaries.

7-12 DAYS; The sac containing the egg grows and estrogen production continues. The inner layer of the uterus gradually thickens.

13-14 DAYS; Ovulation (ovulation) is the release of the egg that reaches maturity in the ovaries. Pregnancy can occur if sexual intercourse occurs during this period. On the days when ovulation occurs, there may be mild pain in the lower abdomen and groin. The body temperature increases during these days, when very little bleeding can also be seen.

DAY 15-28; In the second half of the menstrual cycle, a hormone called progesterone is released from the ovaries. With the effect of progesterone, the inner layer of the uterus thickens and prepares for pregnancy.

DAY 15-18; The egg released from the ovaries comes to the uterus through the tubes. Meanwhile, the estrogen level starts to decrease and a hormone called progesterone is released from the ovaries.

DAY 19-20; The uterus is ready for pregnancy. Progesterone increases the thickness of the inner layer of the uterus called endometrium. This hormone, which also causes premenstrual syndrome, causes emotional changes and skin disorders.

DAY 21-28; Progesterone and estrogen continue to be high. These cause pain and tenderness in the breasts, water retention in the body and excessive cravings for certain foods. When salty foods are eaten, swelling in the body increases. When the egg is not fertilized, pregnancy does not occur, progesterone and estrogen levels drop and menstruation begins.

WHAT YOU WONDER ABOUT MENSTRUAL CYCLES

If Menstruation Has Not Started

Menstruation starts between the ages of 9-16. Menarche (first menstrual bleeding) may be delayed in girls who play sports, as well as in girls who are very thin and lose weight at the beginning of their development. The doctor checks the genital organs. In some girls, the membrane at the entrance to the vagina does not have the opening that should normally be present and that allows menstrual blood to flow out. In very rare cases, the vagina or uterus may be underdeveloped.

How Often Menstrual Bleeding Occurs

Menstruation occurs once a month. Menstrual cycles lasting between 25-30 days are normal. Menstrual bleeding lasts 3-7 days. Bleeding, which is more in the first days, gradually decreases. During the periods when menstrual bleeding starts, this bleeding may not be the same intensity every month. Bleeding may be more one month and much less the next month.

If Menstruation is Irregular

Menstruation can be irregular, affected by body weight, diet, excitement, stress, exercise and illness. The length of menstrual cycles varies in the first years. Irregular menstrual bleeding is normal for the first 1-2 years. After menarche, it takes time for the reproductive organs and hormones to work in harmony.

If Menstrual Cycles Are Too Long

Some girls menstruate only 3-4 times a year. Stress, heavy exercise, sudden weight loss and dieting can cause menstrual cycles to last too long. In addition, hormonal imbalances also lead to prolonged periods. In a condition called polycystic ovary syndrome, which is characterized by excess weight, excessive hair growth and menstrual irregularities, menstruation occurs only 3-4 times a year.

If Menstrual Cycles Are Too Short

Menstrual cycles may be shorter than 21 days due to stress, certain types of exercise and changes in lifestyle. In this case, it is necessary to consult a doctor and undergo a check-up. Excessive bleeding causes anemia. People with anemia should eat more iron-containing foods or take iron pills. The number of days of menstrual bleeding, how many days the bleeding lasts, the amount of bleeding and complaints such as cramps should be noted and sent to the doctor.

Is it important to miss your period for a month

Menstruation may not occur for several months due to stress, illness, weight loss, etc. In the absence of several menstrual periods, a doctor should be consulted.

What Products to Use During Menstrual Bleeding

Pads are the most commonly used products during menstrual bleeding. These are products that are placed in underwear and have high absorbency. These absorb menstrual blood and take it into the inner layers of the pad. Another method is using tampons. Tampon is a product that is not widely used in our country. There are also types produced for young girls that do not damage the membrane at the entrance of the vagina. People with active sexual life use tampons more easily. There are important points to be considered when using tampons. The use of tampons can cause an important health problem called Toxic Shock Syndrome. People who use tampons should definitely change the tampon every 4-6 hours and pay close attention to cleaning rules.

Can you go swimming during menstrual bleeding?

In the past, it was believed that during this period you should not go swimming, do sports and avoid many activities that you normally do. Swimming and other sports can be practiced with the necessary protection. Young girls with pain and cramps should avoid these activities.

What is Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS) is a condition that many young girls experience. The symptoms of Premenstrual Syndrome start 1-2 weeks before menstruation. Emotional changes, breast pain and tenderness, body swelling, acne breakouts and fatigue are the most common complaints. These symptoms disappear with the onset of menstruation. PMS occurs after ovulation. Estrogen and progesterone hormones can cause these symptoms together. Eating a healthy diet, avoiding meals containing high carbohydrates, chocolate, very salty foods, cola drinks and coffee containing caffeine, and resting can prevent these symptoms.

What Causes Cramps During Menstruation

Young girls complain of severe pain in the abdomen and groin area before and during menstruation. These cramps are usually mild, but can sometimes be severe enough to interfere with a girl’s daily life. More than half of teenage girls complain of cramps, while in one in seven the pain is very severe. With menstrual bleeding, the lining of the uterus begins to shed and substances called prostoglandins are released. Prostoglandins cause the smooth muscles of the uterus to contract. During the contraction of the smooth muscles in the uterus, severe cramps can be felt. Sometimes the level of prostoglandins rises too high, causing too much of them. These cramps are more severe in young girls where the canal between the uterus and the cervix is narrow. Stress can also increase the severity of these cramps.

Are cramps during menstrual bleeding accompanied by other complaints?

These cramps may be accompanied by headache, nausea, vomiting, frequent urination and diarrhea or constipation due to changes in bowel movements.

How to treat cramps

Adequate rest, sleep and regular exercise can reduce the severity of cramps. Placing warm pads on the abdomen can also reduce pain. A hot water bag can be applied to the abdomen. However, the water used should not be too hot. Painkillers that reduce prostoglandin production can be used. You should start taking painkillers before the cramps become severe. It is recommended to start taking painkillers the day before the expected menstruation and to continue the medication for 1-2 days after the onset of bleeding.

Do Painkillers Cause Increased Menstrual Bleeding

Painkillers other than aspirin do not cause increased bleeding. Before using painkillers, you should consult your doctor and find out about the side effects of the medicine. A medicine that does not cause any problems in others may be harmful to you.

Is smoking during menstruation harmful?

Smoking negatively affects your health. Scientific studies have shown that smoking also negatively affects reproductive health. The nicotine contained in cigarettes causes blood vessels to shrink and the oxygen demand of organs cannot be met. Smoking can disrupt the regularity of menstrual cycles, making it difficult to have children in the future.

Is it normal to have clots during menstrual bleeding?

It is normal for clots to form in the first few days of heavy bleeding and cramps. Your body produces factors that prevent clotting. On days when bleeding is very heavy, these factors may be insufficient and clotting occurs. However, if the clots are larger than usual, you should consult a doctor.

Does bleeding also occur between menstrual periods?

Bleeding in the form of spotting may occur between menstrual periods. The most common cause of intermenstrual bleeding is bleeding during ovulation (when the egg hatches). This is not a cause for concern. Infections and tumors in the reproductive organs can also cause intermittent bleeding and spotting.

GYNECOLOGICAL EXAMINATION

Don’t be afraid of the first gynecological examination

Gynecology is medical care specific to women to maintain sexual and reproductive health. This care protects against diseases, early diagnosis of cancer, early diagnosis of infections affecting the reproductive organs and prevention of later complications such as infertility.

Procedures when consulting a gynecologist;

For many young girls, the first gynecological examination can be quite unsettling, but given its importance, this appointment should never be postponed. If a young girl knows what to expect at this appointment, it helps her to overcome her worries. First, personal, family, sexual and medical history is taken. A gynecological examination is performed and laboratory tests are ordered. The examination should be done during a period when menstruation is not present. Menstrual bleeding affects both the results of the laboratory tests and the examination. Vaginal douching and the use of creams should be avoided for a few days before the examination.

Identifying the questions to be asked;

Determining the questions to be asked before the first appointment with the gynecologist and taking notes makes the appointment more productive. The information and complaints given to the gynecologist must be complete. All private information given to the gynecologist remains confidential. Providing incorrect or incomplete information negatively affects the treatment and the identification of problems.

What information to give to the doctor at the first gynecological examination

What is conveyed in the medical history

Last menstrual period

Length of menstrual cycles

How long menstrual bleeding lasts

Whether menstrual bleeding occurs

Presence of genital pain, itching and discharge

Whether you have any other medical problems

Information on diseases seen in family members

Information on previous illnesses, surgical procedures and medications used

Information on smoking, alcohol and eating habits

Many young girls are extremely nervous before their first gynecological examination. However, a gynecological examination is an easy and painless procedure that takes no more than five minutes. It is natural to feel uncomfortable before the first examination, and having prior knowledge of what will be done during the examination reduces anxiety.

How to conduct an examination

A gynecological examination evaluates the condition of the genital organs and gynecological problems. For a gynecological examination, underwear should be removed and the patient should lie on the gynecological examination table. At this time, a blanket is given to cover the abdomen and legs, and before the examination begins, it is asked to slide to the end of the table and put the feet on the special attachments on both sides of the examination table. It is necessary to lie with the legs apart so that the doctor can perform the examination. In this position, allowing the person to relax makes the examination process very easy. The doctor examines the external genital organs by wearing gloves. He checks for redness, irritation, cysts and warts. This very short procedure does not cause any pain. The reproductive organs are evaluated with an ultrasound scan of the abdomen. After the gynecological examination, the doctor may order some tests such as urinalysis and blood count.

Although the age of “18” is mentioned for the first gynecological examination, there are situations that require a gynecological check-up regardless of age;

Pain in the lower abdomen

Menstrual irregularities, absence or interruption of menstruation

Severe pain during menstruation

Abnormal bleeding

Pain, swelling, itching, masses and sores in the external genital organs

Vaginal discharge, itching and pain

Absence of menstruation despite reaching the age of fifteen or sixteen

Exposure to diseases transmitted through sexual contact

GENITAL HYGIENE AND INFECTIONS

Maintaining genital hygiene is the most important step in protecting women’s health and reproductive health. In a healthy girl, the genital organs contain many microorganisms called flora. Disruption of the balance between these microorganisms can lead to infections and damage reproductive health.

How to do genital cleansing

Cleaning after the toilet must be done from front to back

The genital area must be dried after cleaning

Unscented and colorless toilet paper should be used

Vaginal, douching, soap, powder and spray use should be avoided

The genital area should be thoroughly dried after bathing or swimming in the pool

Cotton underwear should be used

Underwear should be changed frequently and ironed after washing.

Tight, tight, ill-fitting underwear and pants should not be worn

How to clean the genitals during menstruation

It should be ensured that the pads used are odorless and colorless

Pads should be changed frequently. Unused pads should be kept closed in their bags or in a clean place. Pads that are exposed and handled with dirty hands can carry germs and cause infections.

When there are problems such as itching, redness and burning after using a certain type of pad, a product that does not cause complaints should be preferred by trying a different pad.

There is no harm in bathing during this period. Washing by filling the bathtub with hot water should be avoided. The most appropriate is to take a standing shower.

It is not useful to use products such as perfume and cologne in large quantities to avoid bad odors during menstruation. In particular, applying cologne and perfume to the genital area and using scented pads should be avoided.

What a healthy vagina should look like

In a healthy young girl, the vagina contains many microorganisms that make up the vaginal flora.  Normal vaginal secretions are odorless and colorless. Sexual activity, age, menstrual cycle, general health status and nutrition can cause changes in vaginal secretions. In case of imbalance between the microorganisms in the vaginal flora, one or more of these microorganisms multiply too much and cause infections. In vaginal infections, the amount, color and smell of vaginal secretion changes. Infections caused by fungi are most common in young girls.

In which cases vaginal infections are more common

Keeping the genital area moist

Wearing tight and tight underwear,

Not paying attention to the cleanliness of the genital area

Use of products containing chemicals such as vaginal douching and sprays,

Abnormally high body weight,

Diabetes

Long-term use of antibiotics,

It leads to frequent vaginal yeast infections.

What symptoms vaginal yeast infections cause

Itching and tenderness

White and cheesy vaginal discharge

Burning during urination

It is possible to prevent these infections by paying attention to hygiene. If you have symptoms of this infection, you should consult a physician and get treatment.

Other Common Problems During Adolescence

Facial hair growth during puberty

As adrogens (male hormones) increase during puberty, some hair growth occurs. If hair growth is excessive and menstruation is irregular, a physician should be consulted. In the disease called polycystic ovary syndrome, excessive hair growth, menstrual irregularities, acne and obesity are observed. This disease is diagnosed by ultrasonographic examination and treated with hormone preparations. Weight loss is also an important step in the treatment of the disease.

Is too much exercise harmful?

Regular exercise and sports are part of a healthy life. In young girls who do excessive and heavy sports, estrogen (the female hormone) decreases when malnutrition is eliminated. Menstrual cycles become irregular and amenorrhea (absence of menstrual bleeding) is observed.

Osteoporosis starts due to estrogen deficiency. Amenorrhea is seen in 60% of girls who do heavy sports. When the following symptoms are observed, a physician should be consulted immediately.

Weight loss

Irregular menstruation and amenorrhea

Fatigue, impaired concentration

Muscle injury

Stress fractures of bones (fractures that occur without trauma)

Long-term treatment of this condition can cause permanent damage to bones, reproductive health and the heart. Diet should be adjusted and calcium and vitamins should be supplemented. Hormone preparations can also be used if necessary.

Too much exercise;

Dates of menstrual bleeding should be recorded and monitored

Eat regularly and without skipping meals

Female athletes should receive nutritional advice from a dietitian and should be supplemented with vitamins, calcium and iron when necessary.

It must be remembered that the young girl is doing the sport for herself and that health is paramount.

Why puberty is delayed

The most common cause is structural delay. When investigated, it is learned that some of the other members of the family also enter puberty late.

Chronic diseases such as diabetes, asthma, kidney diseases,

Nutritional disorders,

Disorders of the pituitary and thyroid glands

Genetic diseases

It leads to delayed puberty.

Puberty is delayed in one out of every 100 adolescents. In this case, the girl and her family should consult a physician and the cause of the delay should be identified and treated.