Menstruation Education and other Puberty Resources for Parents

Learning about Menstruation


In 1970 I was in the 5th grade. I vividly remember an afternoon in which all the girls in the class were given a mimeographed note for our mothers to sign and return giving permission for us to stay after school on a certain day to view a film about "menstruation." This was a term that I had never heard of. My classmates didn't have an explanation either, although one boy teased that HE knew what it was all about! We scoured our school dictionary to no avail.


At home, my mother signed the note without comment. She encouraged me to "look it up in the encyclopedia" when I tried to probe further into this mystery. The encyclopedia explanation baffled me, and the sketch of female reproductive organs was as abstract to my 10-year-old mind as a Rorschach inkblot.


Back at school some of the girls asserted that since "menstruation" started with the word "men-," we were going to learn something about boys. One dear little friend then confided some secrets she knew about sex which seemed impossible (but turned out to be true.)


The thirty (or so) 5th grade girls of Willitts Elementary gathered at the end of the day, sitting cross-legged on the cement basement floor of our dear old school. The classroom teachers were joined by the school nurse. Our principal disappeared after he had ensured that any lingering boys were absolutely gone from the campus.


Our film called, "It's Wonderful Being a Girl," featured Libby, a preteen who was learning about menstruation. (Watch it here if you like.) The film featured the Modess brand of menstrual sanitary napkins, understandable as they were products of the sponsor, Personal Products Corp. a division of Johnson & Johnson. It's common for makers of "feminine hygiene" products to offer such educational fare--offering an educational service as they advertise and make babysteps towards influencing brand loyalty. (It was obvously effective, in my case anyway, because I've vividly remembered this film for all of these 35-plus years.) After the film we were given the companion booklet with the (somewhat threatening?) title of, "Growing up and Liking it."


After the film the school nurse gamely lectured the assembled bewildered little girls. As it turned out, a few girls in the other class admitted some knowledge of this subject. Meanwhile, I was still confused and now rather frightened. Sometime later while visiting my friend Sandy, we raided her older sister's room and examined her sanitary napkins and belt--she would have killed us if she'd known. The subject of menstruation never came up again for perhaps a year or so. My mother one day showed me a "starter kit" she had purchased for me for the day I would need it. Ugh! When that day eventually came, I was scared and upset.  Mom was at work and the box was in the closet of her room. I did cry a little bit while telling her about "what had happened" to me that afternoon. She gave me the box and a bit of reassurance and that was that.


Menstruation Resources . . .


Menstruation was never much of a topic of conversation in my life. I don't have a daughter and didn't anticipate having to explain menstruation to my son. But he was inquisitive when a 1999 episode of the animated series, "King of the Hill" featured Hank, the main character, awkwardly coping as his neighbor's daughter started her first menstrual period while her parents and his wife were away. Of course, an 8-year-old boy was satisfied with minimal information. I was surprised at the time to notice in myself the urge to be forthcoming coupled with a reluctance to be specific.  I attributed it to the lack of discussion on such issues in my own life.


I decided I needed to prepare for more puberty talk to come so I did a bit of research and found a great book to help me explain the "need to know" issues in what was then the pre-internet era for my family. Now days there are all kinds of resources online to help educate girls and boys about menstruation and puberty. Again, many of these informational websites are sponsored by personal product manufacturers, but the approaches are subtle and not off-putting.


. . . from the Feminine Products Industry


Kimberly-Clark, the maker of Kotex, offers "My Daughter's Period," an informational web-based brochure that offers advice on when and what to discuss when talking with your girl about puberty. The Kotex website also includes "Girlspace," a sort of social networking application targeting puberty issues.  For the girl or woman who really needs to plan ahead, check out this Kotex Period Planner so that you'll always be prepared.


Johnson & Johnson manufactures a number of different feminine “protection” products including O.B. tampons, Carefree panty shields, and Stayfree sanitary napkins. Their website is worth checking out and includes these notable educational offerings: an interactive website, "Teens for Teens" and for parents "A Guide to Handling Your Child's First Period."


Proctor & Gamble is the parent company of Tampax and Always. Not to be outdone by the competition, their website also boasts a Period Predictor. Most importantly their educational features include, "A Page for Mom" and Beinggirl.com, a website which provides age-appropriate information for pre-teens. The site includes an explanatory section called, "Your Period," which is good information, but I honestly feel it is written over the heads of girls at an age to learn about their first period. Fortunately there are better publications from P&G available for download, namely:  "Always Changing" for boys concerning puberty and "Always Changing," for girls  to explain menstruation. These booklets also serve as companion literature to Proctor & Gamble's,  Always Changing school-based program.


Grade A Plus!!! For any inexperienced young girl, I truly feel this publication is the most exceptional:  "Always Changing," Special Ed Version for Girls.  Although this is aimed at special ed students, I think that the clear, basic explanations in this publication are very appropriate for tender young girls of age 9 and 10. I would also consider this a good choice in cases where English is a second language. Kudos to P&G on this publication.

. . . from Professional and Governmental Entities

• The American College of Gynecologists Educational Pamphlet about Menstruation:  Patient Education (Menstruation)
• Talking to your child about menstruation,. from KidsHealth.org: Talk about Menstruation 
• (And a Spanish Version):  Menstruation Education in Spanish
• Mayo Clinic, Menstruation: Preparing your preteen for her period:  Preparing Your Preteen for her Period
• Girlshealth.gov
• 4parents.gov: Download brochures to help you explain sexual development to boys and girls.

. . . and even More, More, More about Menstruation!

Grade A Plus!!! Find a treasure-trove of vintage Feminine Products Company Booklets about Menstruation (some from as early as the 1920’s.) These booklets are available in their entirety on the Museum of Menstruation website.


My Little Red Book  is a recently published anthology of women's stories from around the world discussing the circumstances surrounding their first menstrual periods.

See comments left below from Elizabeth Kissling of the Society for Menstrual Research.  I look forward to checking out their website.  Thank you Elizabeth!


. .. .

Understanding Medical Terms, Lingo, and Abbreviations

Medspeak, Medical Lingo . . . Need Help in Understanding the Language of the Medical World?

Right now I'm going through a stack of patient information brochures that I've been holding on to for awhile. A standout brochure in my collection is called, "Deciphering Medspeak," published by the Medical Library Association (MLA). This publication provides a quick A-to-Z plain-language guide which helps explain the meanings behind common medical terms and abbreviations.

In addition to the original version of Deciphering Medspeak, the plain language (low literacy) version (pdf) is also available online along with French and Spanish versions: Décryptage du Langage Médical and in Descifrando el Lenguaje Medico.

Other Resources with Medical Abbreviations and Terms:

This online medical dictionary can also help you find answers:  Medlineplus encyclopedia.

If you have ever wondered what the abbreviations on doctor's prescriptons mean, you'll find this to be a useful guide: RX Riddles Solved, A Prescription Shorthand Guide.

For Very Basic Explanations of Health Terms . . .
MLAnet's "plain-language brochures" are written for health consumers with a 5th grade or lower reading level. These publications are ideal for consumers struggling with limited health literacy.  Here is an example of the same health term definition from the original Deciphering Medspeak publication (1) and the plain-language version of the brochure (2):

• (1) DIFFERENTIAL DIAGNOSIS - is a list of the different diseases that can cause these symptoms
• (2) DIFFERENTIAL DIAGNOSIS - a list of diseases with symptoms that are alike. A fever and a runny nose are symptoms. The flu or the common cold are possible causes.

In case you were wondering . . . abbreviations for medical titles and degrees

"MPH" is my highest professional degree. It stands for "Master of Public Health" (not miles per hour, as one friend suggested.)  I earned my MPH from the University of Texas Health Science Center at Houston.  The MPH program requires study in five specific areas important to public health: epidemiology, health education, biostatistics, environmental health, and health services management.  My MPH course also required completion of a thesis.  (Mine was a qualitative study of lost opportunities in umbilical cord blood banking.)  Often, you'll find individuals with an MPH degree working in health departments, for the CDC, or as key personnel in non-profit health organizations.  Physicians, dentists, veterinarians, attorneys, and nurses are among the professionals who pursue this degree.

" D.O.":  In the U.S. we have two types of medical doctors, those with the M.D. behind their names and those with the less familiar "D.O." or Doctor of Osteopathy.  Both types of physicians receive the same basic medical education and pass similar licensing exams.  Osteopaths receive training that is holistic in nature--looking at the whole person rather than one aspect of an individual's symptoms.

"P.A.":  Physician's Assistant.  Many physicians employ P.A.s to serve as mid-level health providers.  P.A.s are licensed to practice medicine under the supervision of a licensed physician.  Their highest educational level is either at the bachelor or master's degree level.  In the clinical setting you'll find P.A.s treating and diagnosing illness, ordering lab tests, performing physical exams and even assisting in surgery.

"N.P.":  Nurse Practitioners are another type of mid-level health provider.  Like P.A.s, they work under the supervision of a licensed physcian.  In addition to a bachelor's degree in nursing, they hold a master's degree and licensure as an advanced practice nurse.  You'll find N.P.s providing individualized patient care, performing physicals, ordering lab tests, prescribing medications, etc. in physician's offices, clinics, and hospitals.

"BSN":  Bachelor of Science in Nursing.  This degree is earned by successful completion of a 4-year-university program.  However, the degree does not guarantee licensure as a registered nurse. All graduates are required to complete licensing exams before entering practice. (Personal Note: I earned my BSN from the University of El Paso at Texas.  This is my highest nursing degree, although I do have a master's degree in public health.)

"MSN": Master of Science in Nursing. After completing a bachelor's in nursing, the MSN degree is the next educational step towards career advancement for the registered nurse.  Nurses with the MSN may be teaching in nursing schools or practicing as certified nurse midwives, nurse practitioners, certified nurse anesthetists, or clinical nurse specialists.

"ADN":  Associate Degree Nurse.  This degree provides fundamental education for registered nurses.  Most RN's practicing today have either the ADN degree or the BSN degree which is a longer program. Most community colleges offer 2-3 year ADN programs in nursing which prepare the graduate for the role of registered nurse.  Graduates must successfully pass state licensure exams before entering practice.

"RN": Registered Nurse.  At one time, RN's were educated chiefly in hospital schools of nursing.  Instead of a degree, upon completion, they were awarded a diploma which entitled them to sit for the RN licensing exams.  Today there are still some "diploma" nurses in the workplace, but RN's are also educated in ADN and BSN programs (see above.)  In addition, advanced practice nurses such as nurse practitioners, midwives, and nurse anesthesists are RNs, but with an expanded scope of practice.  Licensing requirements may vary slightly by state, but the NCLEX exam is the standardized test required for licensure within the U.S..  Even though an individual may hold a degree or diploma in nursing, if they have never passed a licensing exam, or if they lose or surrender their license to practice, it is illegal for them to use the title of "RN."

"LPN or LVN":  Licensed Practical Nurse or Licensed Vocational Nurse.  LPN and LVN's practice basic nursing, often under the supervision of an RN.  I know of LPN programs that can be completed in as little as 9 months; however, at least one year of study is the norm.  Instruction may occur in a community college or vocational school.  An LPN (or LVN, depending on the state in which one lives) is educated in the basics of nursing care.  LPN/LVN's must pass state licensing exams before entering practice in this field.  You will ususally find LPNs working as nurses in doctor's offices, nursing homes, hospitals, and home health agencies. 


Not finding what you are looking for?  Leave me a comment and I'll soon get back with an answer for you.

. . .

24 Hour Urine Collection: How to do it and Why it's done

See my highlighted links at the bottom for links to instructions for this test in Spanish and other foreign languages.


What's the Purpose of Urine Testing?


An incredible amount of information can be obtained from examining a urine sample. In fact, over 100 different tests can be performed on a single specimen. Most of the time a simple "quick catch" specimen of urine (voided into a cup) is sufficient for a basic urine test. Urinalysis results may reveal problems with the body's electrolytes or hormones, the presence of infection, dehydration, evidence of microscopic blood (that can't be seen with the naked eye), drug levels, or problems with kidney function.


Why a 24-Hour Urine Collection?


A small sample of urine isn't always sufficient. In addition to blood tests, physicians will order a 24-hour urine collection if they have reason to be concerned about overall kidney function. This test typically focuses on creatinine clearance, sodium, protein, and urine osmolality. Other substances may be examined in a 24-hour collection; for example, hormone levels, urea nitrogen, or copper. The volume of urine that is voided during the 24-hour period also yields important information.  The laboratory will make calculations based on your 24-hour (or 12-hour) urine collection that will help determine how well your body is clearing waste products via the urine.  This finding will be compared to a blood test that measures how much of the waste products are circulating in your blood.

If your physician hasn't explained WHY he or she is requesting the 24-hour urine collection, ask for details. As a patient, being informed is one of your fundamental rights.

Tips for Collecting Your 24-Hour Urine Specimen


A 24-hour urine collection is easy to mess up, and that can be very frustrating. Just one moment of accidentally forgetting to collect and save the urine during the 24-hours ruins the test, and the collection might have to start all over again . . .

Before the test: Your doctor's office will provide you with one or two brown plastic collection jugs and written instructions. Certain tests may require that urine be placed in a "double container" or that a preservative be added to the collected urine; you'll be given the supplies and containers appropriate for your test.


What you need from your lab or doctor's office:

• Special instructions for the test and a lab sticker with your patient information to attach to the collection container(s).
• Collection container(s)--depending on the size of container the lab stocks--you may receive one or two of these jugs. They are made of heavy brown plastic, not just any container will do for this collection, so be sure to use the container(s) provided.
• Nice to have items--I'd ask for these if they don't offer them to you. For men: A plastic urinal to void into. For women: a plastic "nun's hat" to set in the toilet to collect the voided urine. If you don't have these items, it's okay to void into a bedpan, large plastic cup or bowl, etc. You will pour the collected urine into the brown collection container after each void, so it's nice to have something that pours easily.
• You'll also need: a way to keep the collected urine cool during the collection period. One of the most common ways to do this is to set the brown urine collection jug in larger container filled with icy water (an ice bath). An ice chest (cooler) is another option. It's also possible to place the collection jug in the refrigerator, although there are many reasons to make this impractical.

When to begin? Find out in advance when and where to return your 24-hour urine collection. This information will help you decide when to begin, because if the lab or physician's office isn't going to be open when you finish the collection, you'll have to keep the sample in a refrigerator, cooler, or in an ice bath until you can turn in your specimen. It's often suggested that you begin a 24-hour collection first thing in the morning--but that is certainly not required. However, it is essential that you make note of the date and time that the specimen collection was started and stopped. This information will need to be recorded on the specimen container (and/or label).


Ready to start? Completely empty your bladder by voiding into the toilet and flushing--DO NOT save this first urine sample. The first time you empty your bladder you are flushing away urine that has been building up in your bladder for several hours or more.  That hours-old urine will yield incorrect results if we collect it for our 24-hour specimen.  We want to start with an empty bladder to collect only the urine our body makes during the 24-hour-period. 


Record the start time and determine your stop time. All other urine during the 24-hours will need to be saved and poured into the collection jug. It's helpful to use the same bathroom all day long and post a note with the start/stop time to help remind you to collect all of your samples. Replenish the ice in the basin surrounding your collection jug from time-to-time in order to keep the specimen cool.


Ending the collection: When the 24-hour-collection period is ending, make a last effort to urinate--even if you don't have the urge to "go," you will still be able to produce an ounce or two of urine. Make sure your collecton jugs are tightly capped and labelled with your name, date of birth, collection date and start/stop times.   (Note: If you weren't given a label for your specimen jug, make one and tape it securely to your jug.) Keep the specimen in the ice bath, cooler, or refrigerator until you are ready to return it to the lab or doctor's office. Place your specimen jug(s) in a sturdy plastic bag for easy carrying. (Your specimen will be just fine without being on ice while you return it to the lab or doctor's office---as long as you are not exposing it to heat for a prolonged period of time.)

What If . . . ? Special circumstances . . .

• You filled up the container the lab provided, but your 24-hour-collection is not yet complete. Use a very clean glass or plastic container to continue collecting your urine.  Your brown jug protects the collected urine from light--so if you have to use a transparent collection bottle, be sure to guard it from the light along with keeping it chilled. Using an ice chest would be a good strategy for you in this case--if that's not possible, cover the transparent container with a brown paper bag to protect it from the light.  When you return your sample to the lab, keep the transparent container in a brown paper bag, or some similar technique to keep it protected from the light.
• You have started the 24-hour-collection, but find you need to leave the house for several hours.  Take a backpack with you, a plastic bottle with a secure lid, and a large ziplock bag full of ice.  This will allow you to carry your collection items discreetly.  For ladies, a wide mouthed plastic container will allow you to urinate and pour the sample into your capped bottle.  Your ziplock bag of ice will help keep your sample cool while you are on the go. I know this is a rather bulky idea, but the best I can come up with at the moment.
• For patients with urinary catheters. It would be preferable to start your collection with a fresh catheter bag in place--if that's not possible, it would be nice to clean the existing bag--at least remove the bag from the catheter and give it a good rinse out.. Begin your collection by completely emptying the current catheter bag and flushing the accumulated urine. Record this as your start time. During the remainder of the 24-hour-collection period, empty the foley bag into the brown collection jugs at regular intervals and keep the collection jugs in the refrigerator on in an ice bath just as anyone else would do. At the designated stop time, empty your collection bag for the last time.
• Urine becomes mixed with feces or blood. Do not empty any urine that has been contaminated by feces or menstrual blood into your collection jug. Make note of the time and stop the collection. Contact your lab or physician's office to inform them. In some cases, if enough time has elapsed (12 hours or more), your physician may give the go-ahead to stop the test early. Possibly, you may be asked to start all over again.
• Patients who are incontinent (cannot hold their urine).  Certainly your physician may not realize (or remember) that a particular patient struggles with complete or partial incontinence.  Do let your doctor know about incontinence issues.  Perhaps the 24-hour-test will be impossible because of complete incontinence; perhaps they might recommend a bladder catheter for the test, or perhaps they might allow a shorter period of time (12-hours or thereabouts) for the urine collection. 
• "Oops! I didn't collect every void during the 24 hours!" If you forget to collect all of your urine, the test results may be inaccurate. Talk to your lab or doctor's office before disposing of all that you've collected. If you have already completed at least 12 hours of the urine collection, mark down the time of the last urination and keep your container on ice or in the refrigerator as discussed later in this article.  Talk to your physician's office or lab to let them know what you have been able to collect.  They should be able to use your sample and calculate the important information based on the number of hours you have collected--but it's important that they know the correct number of hours when you turn in the sample.  It's possible that you'll be asked to start all over again, but there's a good chance that they can use what you've collected and make adjustments to correctly calculate the results.
• Why keep the urine specimen on ice?  The ice bath is just a technique for keeping the urine cool enough so that bacterial growth doesn't overwhelm your specimen.  The ice bath should keep your specimen in the 40-45 degree Farenheit range as would your refrigerator.  Keeping a 24-hour-specimen in the refrigerator is really awkward and inconvenient.  Having your specimen container right there in the bathroom "on ice" is so much easier.
• Other questions? Call your physician's office or lab. If you'd like to suggest anything to make this entry more helpful or accurate--please let me know. I'll gladly tweak this entry to make the information more user-friendly.

For further reading, check out these links:

• Procedures and Diagnostic Tests (From the National Institute's of Health)
• Instructions for a 24-Hour Urine Collection (in English) (648 KB) (in Spanish) (32 KB) (also from NIH) 
• Health Info Translations:  Get instructions for this test in Spanish, Korean, Japanese, Chinese, French, Somali, Russian and Ukranian. 
• St. Clare Hospital Health Service: Patient Education Brochure, 24-hour urine collection: These comprehensive instructions allow the doctor ordering the test to also provide specific dietary instructions to follow depending on what element of the urine is being tested. 
• A 2008 Renal/Urology article that discusses how 12-hour-urine samples can be substituted in place of 24-hour-samples:  24-hour-urine collection may be avoidable.

• Please do try your level best to complete the 24-hour-collection for best results.  If you run into a problem with your collection after 12 hours or more, ask your doctor or lab if they can calculate your results using what you have collected.

. . . http://docs.google.com/gview?a=v&q=cache:Yi0raZ73PAEJ:www.ssmhc.com/internet/home/stclare.nsf/0/F8DF7DDC6ED0F94E862574BE004EF645/%24FILE/24-hr%2520urine%2520collection.pdf%3Fopenelement+how+to+do+24+hour+urine&hl=en&gl=us