Best Practice & Research Clinical Obstetrics & Gynaecology
4Menstrual disturbances in puberty
Section snippets
Introduction – Menstrual cycle in adolescence
According to the World Health Organization, adolescence is defined as the age between 10 and 19 years and is a transitional stage between childhood and adulthood, during which significant physical and mental changes occur. The term ‘puberty’ refers to the sum of all the corporal physiological changes taking place in adolescence, which lead to sexual maturation. In females, menarche is the major landmark of puberty, and despite international variations, usually occurs between 12 and 13 years of
Precocious puberty
Precocious puberty in girls has been defined by Marshal and Tanner in 1969, as “the presence of any secondary sex characteristic in a girl before the age of 8, or the onset of menstruation prior to 10 years of age.” In a US study of over 17 000 girls it was suggested that early pubertal development is reported in 15% of white girls and in 48% of black girls, despite the fact that the average age of menarche did not differ among the two groups.10
In most of the cases (90%), precocious puberty is
Delayed puberty
According to Hickey and Balen,3 delayed puberty is defined as absence of onset of puberty by >2 standard deviation (SD) later than the average age, that is, >14 years in females. It is preferable though to define delayed puberty as the absence of menstruation by the age of 14 in girls with undeveloped secondary sexual characteristics.6 In many cases, it is idiopathic but can also occur due to general conditions resulting in malnutrition. Other causes include gonadal failure (in these cases,
Amenorrhoea
Primary amenorrhoea is the absence of menstruation, either in girls aged 16 years who have already developed secondary sexual characteristics or in 14-year-olds who have no development of secondary sexual characteristics. Especially for the 14-year-olds (with the absence of the secondary sexual characteristics), we prefer and suggest the term ‘late puberty’ rather than primary amenorrhoea. Secondary amenorrhoea is the absence of menstruation for 6 months, for these adolescents who had
Hypothalamic amenorrhoea
Hypothalamic amenorrhoea can be classified either into dysfunctional (e.g., due to stress, excessive exercising, eating disorders or weight loss) or into organic. According to ASRM,15 the causes of hypothalamic amenorrhoea are demonstrated in Table 3. Functional disorders of the hypothalamus or higher centres are the most common reason for chronic anovulation. In the majority of the cases, weight loss is the main cause of amenorrhoea.17 Competitive sports have a threefold higher risk of
Hyperprolactinaemia
Hyperprolactinaemia is a common condition in females, affecting about 1% of them and is associated with decreased oestradiol concentrations (mainly due to GnRH suppression) and oligomenorrhoea or amenorrhoea. The severity of the menstrual disorders is positively correlated with prolactin levels. Hyperprolactinaemia occurs in about 15% of patients with secondary amenorrhoea and in 2% of patients with oligomenorrhoea. Galactorrhoea is a presenting complaint in about 30% of cases. Patients with
Hypogonadism (primary and secondary)
In females with hypogonadism before puberty, failure to progress through puberty or primary amenorrhoea is the most common presenting feature. When hypogonadism occurs in post-pubertal females, secondary amenorrhoea is the usual concern. Hypogonadism may occur if the hypothalamic–pituitary–gonadal axis is interrupted at any level. Hypergonadotrophic hypogonadism results if the gonad does not produce sufficient amount of sex steroid to suppress LH and FSH secretion at normal levels.
Premature ovarian failure
Premature ovarian failure (POF) is defined as the occurrence of amenorrhoea, hypergonadotrophinaemia and oestrogen deficiency in women under the age of 40. Estimated prevalence is 0.9–1.2% among all women, while in women with primary amenorrhoea prevalence is 10–28% and in women with secondary amenorrhoea it is 4–18%.26 According to ASRM, POF affects 1–5% of women. Ovarian function may fluctuate, with increasingly irregular menstrual cycles before the final depletion of oocytes and permanent
Dysfunctional uterine bleeding
Dysfunctional uterine bleeding (DUB) refers to painless endometrial bleeding that is prolonged, excessive, irregular and not attributable to any underlying structural or systemic disease. It is a diagnosis of exclusion and it is defined as abnormal uterine bleeding in the absence of organic cause. The organic causes that may lead to abnormal uterine bleeding during adolescence are pregnancy complications, clotting abnormalities, systemic diseases, pathology of the reproductive tract, endocrine
Dysmenorrhoea
Dysmenorrhoea is the most common problem in adolescence and presents as painful menstruation. Pain usually starts along with bleeding start and lasts from 48 to 72 h. Dysmenorrhoea is characterised as primary when no organic disease is present, and as secondary when there is documented pelvic pathology. Primary dysmenorrhoea is more frequent in adolescence and usually starts along with the onset of ovulatory menstrual cycles.
Mild dysmenorrhoea is considered as mild pain with no systematic
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2018, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :When pregnancy is ruled out as a possible cause of secondary amenorrhea, clinicians should begin exploring other possible diagnoses. The presence or absence of clinical signs of hyperandrogenism (severe acne, hirsutism, alopecia, etc) directs further diagnostic workup.9 Adolescents who present with hyperandrogenism should be evaluated for polycystic ovary syndrome (PCOS); this condition is the second leading cause of secondary amenorrhea and the most common cause of infertility in women, affecting 5%-10% of all reproductive-age women.10,11
Venous Thromboembolism in Female Adolescents: Patient Characteristics
2018, Journal of Pediatric and Adolescent GynecologyMenstrual Characteristics and Related Problems in 9- to 18-Year-Old Turkish School Girls
2018, Journal of Pediatric and Adolescent GynecologyThe association between mental health problems and menstrual cycle irregularity among adolescent Korean girls
2017, Journal of Affective DisordersCitation Excerpt :Adolescence is a transitional stage between childhood and adulthood, during which significant physical and mental changes occur (Deligeoroglou and Tsimaris, 2010).
Menstrual Cycle and the Prevalence of Premenstrual Syndrome/Premenstrual Dysphoric Disorder in Adolescent Athletes
2015, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Practicing sports before puberty causes menarche to occur later than in peers who do not practice sports. The delay is generally 1 year and is associated with an increased risk of future menstrual disorders.1,10,11 In our project, statistical significance was shown for body mass in both groups (P = .001), which is in compliance with other studies.10–12