As a practicing Ob/Gyn providing healthcare for female patients, I often get this question from mothers regarding their tween/teenage daughters. Though the guidelines for requiring the first Pap smear have changed, to start at age 21, the American College of Obstetricians and Gynecologists (ACOG) recommends the first 'reproductive health visit' at ages 13-15. This initial visit may not require a pelvic exam, unless your daughter is having menstrual difficulties (pelvic pain, menstrual cramping, abnormal/heavy periods) or is sexually active. Contraceptive options, STD prevention, and the HPV vaccine may be discussed at this visit.
Heavy menstrual periods (medically termed ‘menorrhagia’) is a common GYN concern, and a frequent reason for women visiting their doctors. 10-35% of women report heavy menstrual periods in population-based studies. Though patients may not know the clinical definition of menorrhagia, I believe them when they report ‘heavy periods’… (based on relative changes in their flow compared to when their period was more ‘normal’…or based on their perception of the flow being ‘heavier than normal’.)
Menorrhagia is clinically defined as menstrual flow lasting longer than 7 days…or greater than 80ml (5-6 tablespoons) blood flow…but who really knows how to measure blood flow that way? Admittedly, for both patients and physicians, blood loss is difficult to quantitate by these measures. More relevant descriptions of heavy menstrual flow may include