ADOLESCENT MENSTRUAL DISORDERS: Update
Section snippets
NORMAL MENSTRUAL CYCLE
The mean age of menarche in the United States is 12.7 years. According to 1985 data from Tanner and Davies,31 3% of girls reach menarche before age 11 years and 3% after 14.5 years. A 1997 study of 17,000 girls in the United States indicates that 3% of white girls and 6% of African-American girls have some breast development by age 6 to 7 years.16 These data suggest that the age definitions of precocious puberty and primary amenorrhea should be lowered and that different definitions are needed
Clinical Characteristics
Dysmenorrhea, or painful menses, is classified according to its underlying cause. Primary dysmenorrhea is associated with normal ovulation and normal anatomy. Secondary dysmenorrhea is associated with pelvic pathology. The distinctive clinical characteristics of primary and secondary amenorrhea guide subsequent evaluation and management (Table 1).
Primary dysmenorrhea increases in prevalence from 39% of postmenarcheal girls at age 12 years to 72% at age 17 years.32 This trend reflects the
Clinical Characteristics
DUB is abnormal endometrial sloughing in the absence of structural pathology. Anovulation, with exposure of the endometrium to unopposed estrogen, is the most common cause of irregular or prolonged vaginal bleeding during adolescence.3 The thickening endometrium in the anovulatory setting lacks the stabilizing effect of progesterone that occurs during the proliferative phase of a mature, ovulatory cycle. As a result, the endometrium begins to break down. A much less common cause of DUB during
Clinical Characteristics
Amenorrhea, similar to dysmenorrhea, is categorized as primary or secondary. The categories refer to the timing of onset when applied to amenorrhea, whereas they refer to cause when applied to dysmenorrhea. Primary amenorrhea is defined as the absence of menarche. Secondary amenorrhea is defined as the absence of menstrual periods at some point after menarche.
Complexity and controversy arise on the fine-tuning of these definitions. For example, the chronologic age by which menarche should occur
Clinical Characteristics
The clinical manifestations of PCOS are highly variable and may include oligomenorrhea, amenorrhea, DUB, hirsutism, acne, obesity, insulin resistance, and acanthosis nigricans. PCOS accounts for 30% to 40% of secondary amenorrhea and 90% of oligomenorrhea in adult women and is the leading cause of hirsutism in adolescents.8 It was first described in 1935 as amenorrhea, hirsutism, and obesity and was called Stein-Leventhal syndrome30 The acronym HAIR-AN syndrome was proposed by Barbieri and Ryan2
SUMMARY
Menarche is an important event during adolescence. For most girls, it marks successful progression through puberty and the onset of reproductive capability. Confidential and sensitive discussion of growth and development, body image, menstrual function, and sexual behavior is an important component of the annual health examination. Menstrual problems are common during adolescence and frequently require evaluation and intervention. Although most problems are explained by maturation of the
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Cited by (17)
Abnormal uterine bleeding in the adolescent
2023, Encyclopedia of Child and Adolescent Health, First EditionEvaluation and management of heavy menstrual bleeding in adolescents: The role of the hematologist
2018, BloodCitation Excerpt :Anovulatory bleeding as a result of an immature hypothalamic-pituitary-ovarian axis is a common cause of HMB in adolescents. Anovulatory bleeding is suggested by a history of irregular menstrual cycles occurring in the first 1 to 2 years after menarche, typically characterized by 2 or more months without bleeding followed by bleeding which can range from spotting, to heavy menses, to acute hemorrhage.25 An absence of menses-associated symptoms such as breast tenderness, moodiness, and/or dysmenorrhea may also suggest anovulation.
Dysfunctional Uterine Bleeding in Adolescent Females Associated with Endocrine Causes and Medical Conditions
2010, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Without the stability of progesterone, the lining begins to break down and sloughs irregularly.2-4,17,20 The lack of progesterone also results in a defect in vasoconstriction, contractility, and prostaglandin secretion, which causes heavy and prolonged menstrual bleeding.2-4,17,20 The management of DUB caused by hyperandrogenism involves the identification and correction of the underlying problem and prevention of long-term sequelae.
Dysfunctional Uterine Bleeding
2007, Comprehensive Pediatric Hospital MedicineMenstrual Problems and Vaginal Bleeding
2004, Practical Strategies in Pediatric Diagnosis and TherapyManagement of Menstruation in Transgender and Gender Nonbinary Adolescents
2022, Clinical Obstetrics and Gynecology
Address reprint requests to Laurie A. P. Mitan, MD, Division of Adolescent Medicine, PAV 2129, Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229–3039
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Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio