Everyone goes through puberty, that time of life when young people move toward adulthood. When your child goes through puberty, they may experience many different emotional and physical changes. Some will experience their first period during puberty while others may experience rapid growth and need changes to their treatment. All bodies change in their own way and young people going through puberty can successfully manage their bleeding disorder as they start a new journey towards adulthood.
Puberty is an exciting and confusing time for tweens and teens. This section of Next Step provides important information for parents or caregivers and for preteens and teenagers on how puberty affects those with a bleeding disorder.
This section on Puberty covers:
Going Through Puberty with a Bleeding Disorder
Puberty Basics
Puberty is when your child’s body starts to go through physical and emotional changes to shift to an adult body. For children assigned male at birth, puberty will often start between the ages of 9 and 14, and finish by age 17, although some changes may continue until age 20. For children assigned female at birth, puberty will start between the ages of 8 and 13, and finish between the ages of 15 to 17.
Puberty starts when a part of the brain called the pituitary gland begins to send out chemicals called hormones. These hormones are what cause the changes in your child’s body. The hormones can cause both physical and emotional changes for your child. Puberty may happen in stages, and your child’s body will change in its own way and at its own pace. Everyone’s body is different and there is no right way to go through puberty.
It is important to create a safe space if your child has questions about puberty. Talking about puberty may not be one conversation but a series of conversations over time as your child gets older. Even if the conversations or questions might be difficult or emotional, try to listen, respect your child’s right to privacy, and keep the dialogue open and consistent.
Here are some questions you can ask your child to start a conversation:
- Are you noticing any changes in your body?
- Are you having any new feelings you are not used to?
- Are you ever sad and not sure why?
Changes for Young People
For children assigned male at birth:
Many tweens and teens will have rapid growth spurts when they grow really fast over a short time. This rapid growth can cause growing pains when joints and muscles ache and get sore. Other changes may include:
- Growth of testicles and scrotum
- Testicles will begin to make sperm
- Growth of hair in the genital region, under arms, and on the face
- Rapid increase in height
- Increase in sweating which may lead to an increase in body odor
- Changes in the voice, often called cracking of the voice
- Skin changes and the development of acne
- Emotional changes, such as sudden releases of strong emotions and mood shifts
For children assigned female at birth:
There will be many different stages of puberty. During these stages, one of the biggest changes for tweens and teens with ovaries is starting menstruation, also known as getting a period. Other changes may include:
- Height and weight may increase quickly
- Underarm hair appears
- Pubic hair starts to form in the genital area
- Development of breasts
- Hips become wider
- Vagina may secrete discharge
- Skin changes and the development of acne
- Feelings or emotions that shift quickly or may be different from usual
If you want more information about menstruation, please go to Periods.
These changes may occur at different points during puberty, and some changes may happen more rapidly than others or in a different order than the lists above. It is important to remember that every child’s body is unique, and puberty will look a little different for each tween or teen.
Emotional changes and relationships:
It is common for children going through puberty to experience strong emotions and sudden changes in mood. Due to these changes, it might feel like your child is acting different from usual, sometimes causing stress or conflict. It is important to give your child a safe space to share and express emotions, especially if these emotional changes are affecting others.
If your child is experiencing anxiety, depression, or other signs of mental health issues, talk with your child’s health care provider. While sometimes sudden emotional changes can be a normal part of puberty, it is important to talk with a mental health provider that works with tweens and teens if these emotional changes are a cause for concern.
Hormones affecting your child’s body can have an impact on how they feel about others. Your child may start to develop romantic feelings toward someone new. For tweens and teens with bleeding disorders, these changes may add other concerns. Having a bleeding disorder may make your child feel different or cause worries about disclosing their disorder. Tweens and teens must often educate others about their bleeding disorder and may also have concerns about sexual activity. Open, honest, and ongoing communication about sex, responsibility, and choice can help tweens and teens learn about sex and relationships in a healthy and positive way.
If you would like more information about sexual health, please go to Sexual Health.
If you would like more information about relationships and disclosures, please go to Relationships and Disclosures.
Going Through Puberty with a Bleeding Disorder
Some tweens and teens may experience symptoms of a bleeding disorder from a young age, while other people may not experience their first symptoms until they start puberty.
For children assigned female at birth:
For some, it can be a confusing time especially if your child has heavy menstrual bleeding (called menorrhagia) due to a bleeding disorder. Some people first notice the symptoms of a bleeding disorder because of heavy or abnormal bleeding during their periods.
Having a bleeding disorder may not make any difference during puberty, but for others it might. Girls and people with the potential to menstruate with bleeding disorders often have longer and heavier periods. Frequent nosebleeds or bruises are also common. If a lot of bleeding occurs, they will lose iron in their body. Having low iron causes anemia, which means your child may feel more tired than usual.
If you want more information about heavy menstrual bleeding and how to manage it, please go to Periods.
For children assigned male at birth:
During puberty, it is common to have rapid growth spurts. These quick changes in weight and height may affect how much bleeding disorder medication your child needs. This rapid growth can also cause growing pains and clumsiness, which can lead to falls and injuries. Look out for joint and muscle bleeds in your child.
Body Image and Self-Esteem
Body image and self-esteem becomes very important to many tweens and teens during this time. Tweens and teens begin to pay more attention to how they look, and they often compare themselves to their peers. Having a bleeding disorder may affect your child’s appearance or cause your child to feel self-conscious about bruises, needle marks, or swollen joints. Needing to use crutches or a wheelchair can worsen feelings of being different. Even if your child is feeling different or self-conscious, you can help promote positive body image and self-esteem by encouraging the ideas below:
- Remind your child that everybody is different, and create a safe space for your child to express emotions about their bleeding disorder
- Help you child focus on their strengths, not any physical limitations
- Identify ways to cope when faced with negative emotions
- Help your child surround themselves with people who support them
- Identify personal characteristics and abilities that enhance self-esteem
- Encourage safe physical activity
- Promote positive thinking by concentrating on the good parts of a situation
If you want more information about puberty or would like to provide your child with more details, please go to
