Menstrual Disorders in Adolescents

By Dr. Shalini Shrivastava in Obstetrics & Gynaecology

Nov 3, 2020

The onset of menses in young women is a milestone with personal, cultural and medical ramifications

Menstrual disorders are among the most common gynecological complaints, effecting quality of life of adolescents and young females and can be an indication of serious underlying pathology

An Australian cross sectional study showed that approximately 25% of girls had significant menstrual dysfunction affecting life activities and resulting in school absence. Serious pathology is rare and menstrual cycles do improve with age. Symptoms can often be managed with reassurance and general advice such as use of simple analgesics.

Normal menstrual cycle is of 28 days (24-35days), lasts for 4-6 day, with an average flow of 30 ml

Its said to be abnormal if it lasts for>8 days, have flow of > 80ml, length of cycle is<24 or > 38 days or if there is intermenstrual or post coital bleeding per vaginum

In normal menstrual cycle a girl should change pad after more than 3 hrs.,should use <21 pads per cycle ,should not change pad at night, with no passage of clots and no evidence of iron deficiency anemia

Menstrual disorders in adolescents are due to delayed maturation of hypothalamopitutary ovarian axis seen in first 2 yrs. following menarche and are an ovulatory .Once they become ovulatory they become regular.

Different menstrual disorders are

1. Ammenorrhea –Absent of menses ,which can be either primary or secondary .Primary amenorrhea is absence of menses by 16 yrs of age .Secondary amenorhheais absent menses >3 months in female with previous normal menses
2. Dysmenorrhea –Painful menses
3. Oligomenorrhea –if interval between cycles is > 35 days
4. Polymenorrhea- if cycle length is <21 days
5. Menorrhagia –if flow is excessive > 80ml
6. Metrorhhagia –irregular menses between menses
7. Premenstrual syndrome-Group of symptoms that occur in females typically between ovulation and menses. It includes backache, muscular cramps ,breast pain and heaviness ,moodchanges ,irritation ,depression. They are due to hormonal changes brought in body during menses

Menstrual disorders which needs evaluation-

1. Menses have not started within 3 yrs of breast development
2. Have not started by 14 yrs of age with signs of hirsuitism(excessive hair growth)
3. Have not started by 14 yrs with a history or examination suggestive of excessive exercise or eating disorder
4. Have not started by 15 yrs
5. Occur more frequently than every 21 days
6. Occur less frequently than every 45 days
7. Occur 90 daysapart even for 1 cycle
8. Lasts more than 7 days
9. Require more frequent changes of pads (more then 1 every 1-2 hrs)
10. Are heavy and associated with a history of excessive bruising or bleeding or a family history of bleeding disorders

TREATMENT OPTIONS 

Reassurance and advice about simple measures are crucial .However many girls referred to tertiary care have already tried simple measures and further treatment and intervention is often required

Lifestyle changes made  during menses can relieve a girl from her premenstrual symptoms .It includes intake  of plenty of fluids ,eat balanced diet rich in fruits,vegetables ,vitamins and minerals .Foods to be avoided are coffee ,excess of salt ,sugar and achohol.Takeadequate sleep of atleast 8 hrs.Avoid stress and can take pain killersifrequired.Hormonal treatment is started if and when required

CONCLUSIONS AND RECOMMENDATIONS –

1. Clinicians should educate girls and their caretakers about what to expect ofa first menstrual period and the range of normal cycle length of subsequent menses
2. Once menses begins ,clinician should ask at every visit for the patients first day of last menses and pattern of menses
3. Identification of abnormal menstrual pattern may improve early identification of potential health concerns for adulthood
4. Its important for clinicians to havean understanding of menstrual patternsofadoloscentgirls,the ability to differentiate between normal andabnormal menses ,and the skill to know how to evaluate such patients

CONCLUSIONS

Menstrual cycles irregularities in the first years after menarche may be symptom of pathology demanding diagnosis and treatment .We recommend that menstrual frequency and regularity should be charted from menarche onwards to focus their attention on the need to take care of their health relating to their menstrual problem