OBGYN Talks About Puberty: What to Expect, Why it Happens, and More | Pelvis Party

One of our listeners inspired this episode and we’re so glad they did. 💕 We sat down with Dr. Melissa Richards to take a deeper dive into puberty: when it starts, why it happens, what changes to expect, and how parents and trusted adults can help make this stage of life a little less confusing. Whether you’re raising a tween, supporting a young person, or just wish someone had explained it better, this conversation is for you.
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Transcript

SPEAKER_00 0:00

When do things start changing then? When does puberty actually start? There's a range. Puberty still considered normal puberty. Around age eight, things start changing.

SPEAKER_01 0:14

Welcome to Pelvis Party After Clinic Hours, where we get outside of the clinic and a little off topic sometimes. Today we're joined by Dr. Melissa Richards, who is an OBGYN and division chair of hospital and surgical services. Welcome, Dr. Richards. Oh, hello there. Dr. Richards is a familiar voice and face on the Pelvis Party podcast, one of the founding members of Pelvis Party.

SPEAKER_00 0:41

It's true.

SPEAKER_01 0:42

Yes. We love having her on the show. Today we're going to be talking about puberty and other things. We'll just see where it takes us.

SPEAKER_00 0:51

Let's roll.

SPEAKER_01 0:52

One of the things that I really love about Pelvis Party is hearing from our listeners. Recently, I received a message from a friend, a former colleague who's a mom of a daughter working on a school project on puberty. It reminded me that while there is a lot of information online and available to young girls, it might not always be accurate. Correct. Especially social media, everybody thinks they know something and are an expert on topics. Yes. So we want to break it down, and we're creating this episode for every young girl and every patient so that they know a little bit more about where puberty begins and what kinds of questions to ask, or not be afraid to ask.

SPEAKER_00 1:38

Absolutely. It's such a fun topic. Yeah. Because it's awkward, but we as grown-ups make it awkward. Why is that? I don't know. I feel like it's, I mean, deep within our souls, we're all just grown-up children and we're all trying to fit in, and this is a time where everybody interestingly doesn't fit in because we're all going through something different when we're going through puberty. I don't know. Kids is kids, when you talk to kids about it, they're actually pretty cool about it. And they have all sorts of wild and crazy questions.

SPEAKER_01 2:11

I recently went through this with my son who started dating. And I know I was awkward as heck. And even though I've talked to you many times, Dr. Richard, about different things, I've heard, I've done my research, it was hard to get through. Right.

SPEAKER_00 2:27

It's what I love about these conversations, because I also have a soon-to-be 15-year-old, is kind of letting them lead the conversation because what I prioritize and what they prioritize, kind of two different things are the questions that they have. I actually had the privilege of talking to not one, not two, not three, but four sections of eighth grade health classes. Oh my. Uh-huh. It was great. And the funny thing is, I'm a gynecologist, so male stuff really isn't my jam from a work standpoint. But I feel like it's important, especially for all of us to understand what the opposite gender, opposite sex, what's happening to them. In that situation, it was nice for the young ladies in the room and the gentleman and whoever else was in the room to kind of understand, okay, this is what's happening, especially for eighth graders. They're like in the thick of everything. So you got asked to go to your kiddo school and talk because you're in OBGYN. I volunteered.

SPEAKER_01 3:31

These kids need to know.

SPEAKER_00 3:33

I think it's great. I do think we make it weird. It's normal just talking about very generic sex. It's like everyone in the room, most of us are here is because someone put a penis in a vagina. That's normal. We don't have to make that weird. That's just fact. And when you find out, I don't know, my mom's a nurse and my mom's awesome, but we didn't really talk about what was going on with our bodies. And I had two younger sisters, so I paved the way and what is happening to my body when things started happening and changing. Just a very interesting time in one's life. When do things start changing then? When does puberty actually start? There's a range. Puberty still considered normal puberty. Around age eight, things start changing. And my real focus, once again, I'm a gynecologist and I can only shove so much stuff in my brain. So anything about male puberty, I'm Googling. But female puberty, I got her down pretty good. So yeah, as early as age eight, the start of puberty, it's a process up until age 13, the start, and it's a process. Typically, breast development happens first, and then we start getting hair in areas that we didn't previously have hair, and then a little bit of growth, like those tall girls in school, right? All the girls are taller than the boys for a period of time because it's a little bit sooner. And then typically after those three things happen, then periods start.

SPEAKER_01 5:04

What would be considered normal? And why do people develop or young people develop at different times?

SPEAKER_00 5:11

Yeah, it's there's genetics that play a role. We do know that kids are maybe going through puberty a little bit earlier. There's nutrition that plays a role in when people go through or start the process of puberty and even how long that process takes. I think we know that sometimes high competitive athletes, there can be a little bit, I don't want to say delay, but a delay in going through puberty. There's a lot of different things that can happen, and that's where it's so important to have someone that you can talk to, whether a great healthcare primary care clinician or seeing a gynecologist. This is one of the big things I like to talk to patients about, is you really can have your first well-woman exam or well person exam at age 13. And when you come in, that doesn't mean we're gonna do an actual exam. That means we're gonna just talk through what is happening to our bodies, what to expect, a lot of proactive conversations just to make once again normalize this whole process that's taking place.

SPEAKER_01 6:16

Yeah, I think that's a huge thing with the exam piece of it as a young person. It created a lot of anxiety every time I would go to the doctor's office thinking that, oh, I'm gonna have to get naked, I'm gonna have to sit down and they're gonna be doing their normal touches, right? With consent. Um, but I think to normalize that, that the first time it really is just a conversation to see what's going on.

SPEAKER_00 6:37

We're just talking. And I will literally walk in the room, sit down, and level set. And usually my nurse is also level set. No one's getting naked today. We're just gonna talk through it. You have choice. Every time you come to the doctor, you have choice, and that's really powerful. Both my sisters are teachers, and I was talking to my middle sister who teaches health and viad, and talking about the importance of consent and how that is such a focus. And I really took that to heart and making that a part of when I talk to patients, especially young people, about the importance of consent and it travels into the doctor's office. Like, I want to make sure you're okay with this and I get consent for whatever we're doing or talking about.

SPEAKER_01 7:22

Even as a parent, I oftentimes we unintentionally shut our youth down by saying, Nope, you can't do that. Nope, you can't do that. But in this case, when they're in the room with you with a provider, if there's something that makes them uncomfortable, or for whatever reason a provider maybe reached to start an exam, just to say, like, can you explain what you're gonna do first? That's absolutely okay.

SPEAKER_00 7:43

Yep, it's great. And sometimes we just get into the motions, right? I do pelvic exams every day. And it's just something that I do and somewhat, in my opinion, take for granted sometimes that this isn't like a normal thing that people come to the doctor every day. And usually we'll even if I'm doing an exam, a patient will say, Oh, this is this is kind of horrible. And I'm like, I get it. I totally get it. But my job is to make you feel comfortable. I'm gonna be talking to you the entire time and just we got this. You can do this, you're doing an awesome job. Especially like when people have issues, especially young people have issues with their periods that are really heavy. Some of the great ways that we can help manage those issues, like heavy, painful periods, are through IUDs, right? So an intruder and device that involves a pelvic exam. That involves me touching the cervix, that involves perhaps some cramping. That's a big trust game between myself and the patient. And typically their family member is there to support them. And that for me is really rewarding when I have a patient come in who's kind of side-eyeing me, like, what are you gonna do to me? And then knowing that they've done their research, right? They've Googled, they've looked up things, they've followed through social media, and they know that they want to do something like perhaps an IUD, but they've also Googled and through social media watched videos. Um, I mean, boy, people literally live streaming their IUD placement. And that can be scary going into that. And I just feel like such a winner when at the end of the whole thing, a patient's like, oh my gosh, that was way better than I thought it was gonna be. I did it.

unknown 9:28

Yay!

SPEAKER_00 9:29

Win for me.

SPEAKER_01 9:31

You talked a little bit earlier about changes to the body. I'm guessing everybody's timeline is a little different. Sweat, body odor, that increases. You start to get a some youth experience more acne, changes in body shape, brain development. Can you talk a little bit more about the physiological changes that happen?

SPEAKER_00 9:51

I mean, yes, absolutely. All those things happen. They're kind of happening on their own timeline, but they typically follow each other. So it feels like you almost get stuck in one of those timelines. Breast development happens, height happens, hair happens, and then no period. And years go by and no period. That is concerning. But if it feels like it's happening almost, I would say like year after year progressing, that's completely normal. I kind of stutter step with these things because it's so individualized, depending on the situation behind each patient that we want to make sure that's normal for that person, but another person that's absolutely not normal. Does that make sense? Yeah. So first period sin, how do you know it's coming? Great question. It's like the great mystery of all uh typically people don't, you don't know, right? And that's where it's really neat. As much as sometimes I beg on social media and some of the stuff that's out there. There's some really cool resources that are out there about your first little period kit that you can have. The importance of being able in your backpack having it depends on if you want to be loud and proud, that's awesome. Have a big pack that says tampons included. But even just something super discreet, you can have a tiny little box that has some panty liners. Typically, they're not ginormous blood baths of periods. Typically, they're pretty light when they do happen and cramping and then notice go to the bathroom because they maybe I'm peeping my pants a little bit and see blood. That's usually the story that we all experienced. Yep. And when that happens, what would you recommend a patient do or a youth? Absolutely. I think hopefully we've had some conversations beforehand with a trusted adult to be able to say it happened and be able to have that conversation. And if you are a trusted adult who feels a bit uncomfortable having that conversation, give a call, phone a friend, man. I almost guarantee everyone has a goofball friend like yours truly that would be willing to walk through. Okay, these are the things that you want to make sure that you have, right? Uh pads, different types of pads, also warning signs. I don't necessarily expect, once again, monster periods or crazy painful periods. We shouldn't live, I think, also in fear of our periods, especially as our bodies are changing. But if noticing the warning signs of heavy periods where I feel like I can't get off the toilet because I'm bleeding so much, or so much pain and discomfort where over-the-counter pain relievers such as acetaminophane or tylenol or ibuprofen motrin doesn't cut it, make a phone call. Yeah. Should not be intense. No, it breaks my heart when I hear about kiddos that have been missing school are getting in trouble because of their periods. It also drives me crazy. And I feel like schools are doing such a better job. If a kid's got to go to the bathroom, just let them go to the bathroom. Because I have seen the patient who they bled through their pants and they're trying to go to the bathroom. And the teacher's like, mm, they'll say, My teacher wouldn't let me go to the bathroom. They figure it out, right? They borrow someone's sweatshirt. Like you hear those wonderful stories about like friends who like offer a sweatshirt to tie around your waist. That's a trick. If you didn't know that's a trick, that is a Dr. Richards trick from seventh grade. I definitely had a sweatshirt with me just in case. Totally.

SPEAKER_01 13:34

As an adult, actually.

SPEAKER_00 13:35

Yeah, it works really well. It's a good little trick. Missing a bunch of school because of your periods, that's not fair. That that actually makes me quite angry because that's not fair. Education is power, and you can't let your periods take away your power, man.

SPEAKER_01 13:51

What about some of the emotional things that lead up to a period? We've got a lot of hormones in Nighthouse. My son's not on a period, but just in general, going through puberty, the emotional, hormonal roller coaster that occurs. Can you tell us a little bit more about that and why it's happening?

SPEAKER_00 14:09

Yeah, I think your hormones are trying to figure out stuff, right? So there's this nice balance in theory that happens with your normal menstrual cycle, this discussion that your brain has with your ovaries. It tells your uterus what to do. And sometimes that situation, especially when your body's trying to figure out how to use these ovaries, can kind of overshoot a little bit or undershoot. And not to mention everything that's going on around you. Friends are also going through this. So it's like feels like a war zone, a playground war zone. Your parents are also, or the people that you live with, the adults that you live with are going through this changing human. And so they're trying to help to navigate. What I find interesting is sometimes I can be a little wild, maybe a little PMS-y, a little premenstrual syndrome. But if the people around me aren't, we can get through something. But when you have two PMS-y people, that can make for some craziness, right? So also that contributes to those maybe hormonal fluxes and mood fluxes that we see with everyone.

SPEAKER_01 15:21

It's just a lot to go through. Yes, definitely. And it helps explain it a little bit too. You know, it's you're on a continuum of things changing. I know I just give a forewarning in my house. I think this is the week that it's right before.

SPEAKER_00 15:34

I'm sorry. Yeah, it's wild, right? And as I'm getting closer to ending this journey of periods, the PMS symptoms are definitely more there. I recognize them more. And I kind of am trying to embrace them. Like I'm spicy, man. I just I'm spicy this week. And then I know I'm gonna get my little period with my IUD in. And then the next two weeks, I'm like, what's up, world? Everything's beautiful. Oh, the world's falling apart around me. It doesn't matter. I'm still in a I can get through this and kind of understanding it. And that's how I'm I do pretty well with that. And that's not everyone's journey, but for me, I'm like, oh, recognition, like, why am I so cantinkerous right now? Also, to be clear, there's a fine line of identifying someone's you you don't need to point it out for me either. Please don't. Person already knows. I know. I'm aware. I'm aware. I'm aware. Thank you for your support. Mm-hmm. Totes.

SPEAKER_01 16:31

Yeah. Just hugs and love. Yeah.

SPEAKER_00 16:33

That's what we need. It's good. Just just understand. Be understanding.

SPEAKER_01 16:37

I'm sure a lot of schools teach what's happening during the period. Can you just for listeners, can you explain it? Because I think I need a reminder, honestly.

unknown 16:47

Right.

SPEAKER_00 16:48

Egg dropping. Yeah, it's a wild situation. And this is where we're doing a audio as opposed to a visual today. And I love though when I go, I actually talk to a couple different schools, and it's really neat how, especially in our community, we have a lot of smaller schools. I live in Winona, but I also go out to like the Plainview health classes and talk to them, Blooming Prairie, talking to the anatomy class there. And then most recently here in Winona, talking to my kiddo's class, going through what the normal menstrual cycle is. It's normally every 28 days from the first day of your period to the next first day. The length matters and the number of days and how much you're bleeding. But when I'm trying to think of timing, it's the first day to the next first day. So that's really key because I'll ask, I have to be very careful on how I say this. What I will literally say how many days between the first day of your period to the next first day. Because if you are using a different day, then your periods might seem a lot shorter in timing. Anyhow, I go off. Periods are normally every 28 days, plus or minus seven days. So you can get a period from day one to the next day one, every 21 days. That does not sound like fun to me, but that is normal in timing. And then up to every 35 days. And they shouldn't really flux by more than a couple days. But once again, when you're starting puberty, that's where you can see more fluxing around.

SPEAKER_01 18:13

I guess I've never heard it explained like that. So let's say you have someone who on the 10th of every month typically I'm not talking about my yes. On the 10th of every month, they're getting their period or they're expecting it. Yep. But that could fluctuate a day or two. Yeah. Or yeah, yeah. Totally. Second of the month to Yeah.

SPEAKER_00 18:33

I mean, that's getting kind of wild. Yeah. Like, so what I'm saying is it is normal for someone, I get a period every 21 days. And then another person say, I get a period every 28 days. And then another person, I get a period every 35 days. Those are all normal. But the person who says, well, one month, it's 21 days, another month, it's 32 days, another month, it's 25 days. That's irregular, that like little flux in there. But when you get your period, you're kind of almost working on your next period a little bit. That's your brain starts releasing hormones that tell your ovaries, like, hey, buddy, let's start a race of a bunch of little cysts. Like a bunch of little cysts start racing. Not just one cyst, but multiple cysts start racing because on about day 14 of your cycle, one cyst wins the race, becomes a dominant follicle, the follicle that releases the egg. And then the other cysts say, Good job, dominant follicle, and then they die. And that's fine. We've got lots of, lots of potential cysts that all have eggs in them. And then that single cyst that released the egg now kind of supports that time it takes for an egg and sperm to get together. An egg and sperm meet in the fallopian tube, make an embryo, and then implant, take a little trip into the uterus and then implant. And during that period of time, that's happening in those 14 days following ovulation. And then that cyst will actually stick around until the placenta is made when someone becomes pregnant. Now, most mons people don't get pregnant, right? There's no sperm involved even. So typically what will happen is those 14 days will go by where you have this cyst that ovulated on an eggs. Once again, if for those keeping track, 14 days, you have this race, you make this dominant follicle or dominant cyst on day 14 in a 28-day cycle that releases an egg to go find sperm. Sometimes it's a lost cause game, and that's okay. And then that cyst sticks around for 14 days. And then if an egg and sperm do not come together, that cis ruptures, goes away. I know you make a ruptured cyst every time you ovulate. People are like, I had a ruptured cyst once. I'm like, every time you ovulate to make a ruptured cyst or buddy. And then that cyst that was putting out a hormone, uh progesterone hormone, when that progesterone goes away because that cyst ruptures that was pushing out all that progesterone. That progesterone going away causes you to shed the lining of the uterus, causing your period the bleeding.

SPEAKER_01 21:10

I see an animation in the making, or there's got to be a really good one out there. The cysts racing each other to dip thing.

SPEAKER_00 21:16

I love it. That was a great analogy. Exactly. I used to refer to it as they're all racing, and then one wins and the rest die. And I heard someone describe it as no, they're all cheering on that one and then they die. It's a team effort to get that one ovulatory cyst out.

SPEAKER_01 21:32

Yeah.

SPEAKER_00 21:33

I like that a lot. Very visual on an audio podcast.

SPEAKER_01 21:39

So let's talk about cramping. Cramping can happen during ovulation, but it can also happen during your period, right? Mm-hmm. Yep, yep, yep. I'm really curious about the ovulation phase and why the cramping is happening. And it can be really intense for some people.

SPEAKER_00 21:53

Right. And it's interesting because everyone's a little bit different. And also in their phases of Life. I probably up until the last couple years when I ovulated, I was like, I I didn't even know I ovulated. But then more recently within the last couple of years, I'm like, I know when I ovulate. Same. I can feel that. I can definitely feel that.

SPEAKER_01 22:17

Mid 30s, that was same for me. And all of a sudden it's like it's for a couple hours, too.

SPEAKER_00 22:23

Yeah. We think, I mean, that happens when the ovary that cyst releases the egg, and then you get a little bit of fluid or blood and kind of in your belly. And that's new stuff. So our bellies are really smart. So you've got your guts in your belly, you've got your uterus, you've got your ovaries, all sorts of stuff. And when new things are introduced into our belly, our belly's like, that's not normal. And so when you have that cyst, it releases the egg. A little bit of fluid probably leaves that cyst. And that's irritating for the inside of our belly. And our belly wants us to know about that because it wants us to live. And that's probably what we're feeling is just that irritation that has happened in our belly. And for some people, they don't even know. And some people it can be pretty impressive. And then pain when you have your period, there's actually a fancy word for it. It's called dysmenorrhea. And when we think of it, I usually think of primary dysmenorrhea. That means basically junky periods, just in general. When you start bleeding, it's a time of inflammation and these fancy things called cytokines, and like the uterus starts cramping to try to get everything out. And that is not a fun experience. And then there's something called secondary dysmenorrhea. And secondary dysmenorrhea means something else during your period is causing the pain. Endometriosis. Endometriosis is when aligning kind of similar to what we shed during our period grows outside of the uterus. And that tissue can get really inflamed. And it's interesting, about 10 to 15% of people with uteruses have endometriosis. We could talk on and on. That's a whole podcast in itself about how it's underdiagnosed and oftentimes undertreated and still pretty misunderstood. But endometriosis can cause significant pain during someone's period. And then one that's really interesting that I don't see very often is called congestive dysmenorrhea. And that is like literally when you have a bunch of blood that forms a clot in your uterus, and your uterus is pushing it out of the cervix and it dilates the cervix. And people usually say, like, oh, I have so much cramping. And then I pass this big clot, and I feel so much better.

SPEAKER_01 24:37

We keep coming back to everybody's body and journey is so different, right? Like we're all experiencing different things. Absolutely. I think the one thing I'd want to say to youth is there's no question that's too embarrassing to ask your primary care is your OBGYN if you end up scheduling an appointment for that. And definitely find the trusted person that can talk through some of these topics about. Because they're not issues, they're completely normal. Let's do a couple of myths that need to be busted.

SPEAKER_00 25:08

Oh, I'm so excited. Myth. Tampons aren't for young girls. That is totally a myth. Like tampons are interesting, and I feel like tampons to me represent you've got lots of options. So tampons are fine for young girls. You can absolutely absolutely use tampons. But then I think it's also important to remember that there are pads, there are period underwear, there are discs that we can use, cups, all sorts of cool ways to help manage your periods. Busted. Busted. Periods should always hurt. Periods should not always hurt. I think it's really interesting how we have this feeling that's our burden to bear. Periods don't always need to hurt. I have people who are like, yeah, it's nothing. It's nothing. But when your periods are impacting your ability to do normal activities of daily living to live your life, no. That's not normal. Nope. Myth, you can't swim during your period. That's so fascinating. The swimming during your period, you can absolutely swim during your period. I remember thinking that as a young girl. Isn't it interesting?

SPEAKER_01 26:13

The blood would somehow still come out in the water, and then it would be this whole big embarrassing thing.

SPEAKER_00 26:18

Yeah. There's some fancy like physics behind that too. The swimming and period and how it doesn't do that. The water. Mm-hmm. It's crazy. Our bodies are amazing. Busted. Busted. You can totally swim with your period. Discharged means something is wrong. Definitely busted. No. Your body, your vagina is amazing. I I don't know. I have mixed feelings about this statement, but it is a self-cleaning oven. I don't know how I feel about that. But I would also like to point out ovens don't really self-clean themselves. They do have some of them have a button. A button, but then you still have to clean it. Yeah, it's true. I refer to it in my documentation as normal physiologic discharge. That's super normal. That's super normal. Now you can have infection, right, with vaginal discharge. That can happen. And some people have a lot of discharge. And that's always an interesting and frustrating. It's a great reason to see a clinician who's going to stick with you while we try to figure out how to decrease your very increased vaginal discharge. That's a tricky one. Usually I can get there one way or another, but I have to be pretty creative and usually phone a friend in what other people have done for patients who are like, my vaginal discharge is out of control. It is impacting my life. I'm changing my underwear three to four times a day, and there's no sign of infection. Completely normal tissue, everything looks great. But this is like driving them crazy. So we usually figure out a way to help with that. But that usually is a journey visit, multiple visits.

SPEAKER_01 27:49

And the sign of infection could be smell.

SPEAKER_00 27:51

Smell, yep. I'm always like careful with smell because our body does smell. And also just think of where your nose is. The nearest opening to your nose is it's a straight shot to your vagina. You might smell something that's completely normal that no one else can smell. But yes. Like we've all experienced. Yes, it's like a straight shot. Yeah. However, yes, infection can smell, especially something called bacterial vaginosis, that can have kind of like a fishy smell that's really foul. And then also like itching is typically a sign. Sometimes discharge can be impressive in how it looks, like it's not clear. That can be a sign of infection. But if you have questions, you can just ask. Come on in. Let's check it out. White discharge is normal too. Yeah. Clear white discharge. Mm-hmm. Absolutely.

SPEAKER_01 28:44

Well, again, that's a wrap on pelvis party after hours for today. We just wanted to bring some different content outside of panic, different topic. Puberty isn't something to be embarrassed about by any means is a sign that your body is doing exactly what it was made to do. It's awesome. We all do it. Dr. Richard said, our bodies are phenomenal and they work for us. The more we can normalize these conversations, the more competent the next generation will feel asking questions, advocating for themselves, and knowing when something doesn't feel right. If today's episode resonated with you, like and follow us on our social media accounts. You can find us at Pelvis Party on Instagram and TikTok. You can also listen to us wherever you get your podcast. Dr. Richards, as always, thank you for being our expert guest and bringing us really good educational content. I love it. Thank you so much for letting me be here today.