Table 2.

Quick Guide to Periods in Adolescents: What's Normal/What's Not

Puberty

Too early (termed precocious puberty): Before age 6 in African Americans or before age 7 in whites

Too late (pubertal delay): No breast development by age 13

Breast Development

Typically around age 11

Too early: Before age 6 in African American or before age 7 in whites

Too late: If no breast development by age 13

Menarche

Typically age 12–13; African American slightly earlier than whites

Too early: Before age 9

Too late: No period by age 15 or by 2.5–3 years after the onset of breast development

Menstrual Cycle Length

Adolescents: 20–45 days

No periods for > 90 days (ie, amenorrhea) is abnormal in reproductive age women

Menstrual Flow Duration

Typical: 2–7 days

Menstrual Flow Volume

Typical: 35 mL (the textbook answer – of no practical worth)

Average tampon/pad use: Each pad or tampon lasts 3–4 hours

Excessive: ≥85 mL leads to anemia if ongoing

Soaking a pad or tampon in 1–2 hours for more than 2–4 hours is a practical definition, particularly if associated with feeling light-headed or dizzy