Puberty a perplexing phase

By SHARON CHAYRA

VIEW ON HEALTH

Rites of passage have existed through the ages. Though both boys and girls participate in such ceremonies, it is more typical that the girls' rituals reflect a challenge to better prepare them for the labors waiting, including that of giving birth.

When a Navajo girl enters puberty, she participates in the life-affirming kinaalda ritual. The young girl's extended family celebrates for nearly a week. The maiden dons a dress made of buckskin and her hair is twisted into a special plait. Over the period of days she rises at dawn and runs to the rising sun letting the radiant beams imbue her with purposeful endurance. She is expected to run further and faster every day.

At the end of the day's long ritual, the young woman is escorted by an older female relative who teaches her the Beauty Way, massages her body, and instructs her on male-female relationships. At the conclusion, the girl and her family prepare a huge corn cake and stay up all night singing and praying with the medicine man.

The sole purpose of the kinaalda is to prepare the woman for the rigors of womanhood including her need for physical strength, character and finding a partner. This ceremony occurs after her first menstrual cycle.

In contemporary U.S. society, such elaborate community-based rituals rarely exist. Those that mark the transition from childhood to adulthood usually focus on getting a driver's license, getting to vote, dating or being able to drink alcohol.

But for a young woman, there is perhaps no greater milestone than the arrival of her first period. Long before she experiences the first dew of womanhood, however, her body has been busily preparing for this transition. Many girls entering puberty have mothers who are entering menopause and experiencing the same hormonal flux.

For boys, puberty -- a time of great physical and emotional development -- starts between the ages of 10 and 15. Puberty in girls starts between the ages of 8 and 13. Each person is different so some start earlier and some start later but most fall within these ranges.

Female puberty is primed by the release of gonadotropin-releasing hormone or GnRH from the brain. This causes the pituitary gland to release luteinizing hormone or LH and follicle-stimulating hormone, or FSH, into the bloodstream. This triggers production of the hormone estrogen. Estrogen, together with FSH and LH, causes a girl's body to mature and ripen an egg in preparation of pregnancy. When pregnancy does not occur, a girl has her period.

Amazing things can happen during puberty that don't occur any other time in a human being's life span. First, a girl's breasts begin to grow, her hips round out as her waist narrows. She gets pubic and armpit hair and her growth is accelerated. The joke about growing overnight is not too far from the truth and often results in a greater clumsiness as the body learns to adapt to longer limbs and bigger feet.

Most girls grow the most in the six months preceding their first period. In fact, around the age of nine, girls begin to gain about 18 percent of their adult height. Many parents feel unprepared for these changes, and not simply because it is the first menstrual cycle, but because it signifies a shift in the relationship between parent and child. It is the beginning of the path a daughter will take as an adult.

Sarah, 25, recalls how hard her father took her becoming at woman at 14. "He was really upset. Not mad, but almost sad in a way. It was like he was preparing to let me go, but he wasn't actually ready when the day came. He was losing his little girl in a way."

Sarah's father acknowledges the melancholy he felt at realizing his freckle-faced munchkin was now becoming a woman. "It seemed like only yesterday she was a gap-toothed five year old making me dinner in her playhouse and now, she is preparing for that day she will really have her own household. That realization that there she's no longer playing pretend but being an actual adult hit me pretty hard."

In addition to significant physical changes that occur at the onset of puberty, emotional changes also occur.

Tarra, 19, remembers she was watching TV when she first started her period. "I cried and cried," she says. This competitive athlete still finds herself crying a lot in the week before her cycle. It's either that or Tarra becomes particularly aggressive on the soccer field, says her 46-year-old mother, Dawn.

Crying jags, aggression and other mood fluctuations are often brought about by premenstrual syndrome or PMS.

Premenstrual Syndrome or PMS is a common complaint for women. The condition has been studied globally and researchers have found PMS in adolescent women adversely affects their emotional well-being, educational performance and general quality of life. Interestingly, PMS symptoms are also believed to be affected by a girl's ethnicity, family history and cultural expectations.

The American College of Obstetrics and Gynecology outlined objective criteria for PMS. Symptoms that cause dysfunction are estimated to impact 20 to 40 percent of reproductive women. Approximately 85 percent of women who menstruate have at least one premenstrual symptom.

Symptoms include weight gain and bloating, breast tenderness, mood changes, headaches and food cravings. A severe subtype of PMS is premenstrual dysphoric disorder, or PMDD. This affects approximately seven percent of menstruating women and causes feelings of depression, insomnia, feeling overwhelmed, constant irritability and anger that cause conflict with other people and lack of energy. It's important to note that depression, thyroid disease and chronic fatigue syndrome can mimic both PMS and PMDD so it's important to see a healthcare provider if these persist.

Most PMS and PMDD symptoms can be improved by aerobic exercise, relaxation techniques including meditation and yoga, as well as dietary changes including more complex carbohydrates and less caffeine, sugar and alcohol. There may also be occasion for medication therapy. Most of the time PMS and PMDD are treated with anti-depressants but oral contraceptives and diuretics may also be used.

In addition to the hormonal shifts, a young woman's mood is also affected by the transition from child to woman. She's exploring who she is, what she wants, her role in this world and a variety of other considerations.

For Katie O'Neil, 16, she says going through adolescence hasn't been as tough as it has been for her older sister. Katie's mother, Dawn, also remarks that her daughter's focus for the future is remarkably lucid. "She's looking forward to getting married and having exactly three children; two boys and a girl," says Dawn, "this is after she completes her business degree at Florida University and marries a professional man with blonde hair and blue eyes who has lots of money!"

A young girl's identity is intricately bound to her place in society. An identity she develops by making plans, making mistakes, making connections and moving forward. One of the reasons coming-of-age rituals are so significant for girls is that their roles are often defined by their relationships with others. It is not unusual for little girls to play dress-up and house, planning for the day they'll get married.

Fitting in and social identity are powerful elements of growing up, even amongst those who identify as gay/lesbian/bisexua/transgendered. "Pairing up is natural for all folks," says social psychologist Jeannine Klein, "but it can be more problematic for LGBT individuals due to existing social stigmas."

The next big step in womanhood usually comes when she is ready to say 'I do.' Those two words symbolize a sizable transition from girl to woman. Society sees marriage for women as a sign they are ready to be caretakers. Ready to assume the responsibility of a household with the idea that one-day children will fill that house. But even if marriage is not part of the equation, committing to one person comes with certain external expectations.

"As soon as I got married, the next question out of my mother's mouth was, when are you having a baby?" says 23-year-old Michelle.

The average age at marriage in the United States is 25.1 years for women. However in the last 20 years, women show a considerable increase in age at marriage. Women are three years older on average now than the mean marriage age in the 1980.

Marriage isn't the only thing happening later in life. Women in this day and age are choosing to have children later and later. Although the average age is 25, more women are having children after the age of 30. An increasing number of women end up postponing motherhood, sometimes focusing on their career, traveling the world or doing other things that are more difficult when you have children. Women have options and want them including having a career and a family.

One of the important options to consider as a woman is birth control. Choosing the right method depends on many factors including age, personal preference, health status, lifestyle and whether contraception is to be reversible or permanent.

Today's options still include birth control pills. These pills interrupt ovulation and have to be taken every day in order to be effective. What has changed with the pill are the variety of formulations including those with lower dose hormones to reduce side-effects or those that can be taken and allow for a menstrual cycle every three months versus every month.

In addition, diaphragms, cervical caps, spermicides and condoms are usually the most reliable forms of temporary birth control. Some couples rely on natural family planning methods such as rhythm method or the withdrawal method. Permanent birth control is achieved through sterilization including a tubal ligation for a woman or a vasectomy for a man.

There is a new product on the market called Essure that purports to be a 99.74 percent effective form of permanent birth control for women. This requires a brief in-office procedure performed by a doctor where micro-inserts are placed through the vagina into the fallopian tubes. This creates scar tissue in the tubes that, after a period of approximately three months, becomes a physical barrier preventing conception.

Finding the best method for pregnancy prevention requires a discussion with your partner and a healthcare provider.

Sonya recalls the struggle she had with the decision. "I know that having children is the ultimate sign of being a woman, but I wanted more. I needed a degree and a career I could call my own before I had a child I could call my own."

The idea of becoming a woman has changed in the last 50 years. What used to be considered important is viewed differently today. While women still strive to have the "perfect" family, the truth is women are redefining what that family is whether through marriage, adoption, childless living or alternative lifestyles.

In addition, many women are economically independent, so there is less of a rush to get to the altar. They can take their time to find the right partner. More work and education are often the culprits in delaying the entire process of starting a family.

It is this delay, however, that has contributed to the increase in infertility.

"As a woman ages, the quality and quantity of her eggs declines," says Eva Littman, a reproductive specialist. An option to helping ensure a chance at biologic parenthood is through the preservation of eggs through "egg freezing."

Still, whether a woman defines herself through her offspring or not, she has grown tremendously physically, emotionally and socially over a span of a decade. She is in the summer of her life, enjoying what statistically is her prime.

"'You've come a long way, baby' used to be a slogan and a song," says Klein, "But it truly reflects the progress women have made in business as well as socially and educationally. As women age, rites of passages exist by virtue of the choices we make."

Hannah, an older mother who went after her career first, says "Somebody said to me once: 'You can have it all -- you just can't have it all at once,' and I really think that's right."