Menstrual disorders in adolescents

Abstract

Menstrual disorders are one of the most common concerns in adolescent gynecology. Therefore, it has recently been proposed that the menstrual cycle should be considered as a vital sign. The main menstrual disorders are abnormal uterine bleeding (AUB), dysmenorrhea and amenorrhea or oligomenorrhea. Clinical history and physical examination are the basis for the evaluation of these adolescents. In some patients, radiological and laboratory studies will complement the diagnosis. AUB is considered when the menstrual cycle lasts longer than 7 days and occurs more frequently than each 21 days. In adolescence, the immaturity of the hypothalamic-pituitary-gonadal axis is the main cause. Normally, AUB is seen more often during the first menstrual cycles. Treatment aims to decrease morbidity and medical treatment is sufficient in most cases. Amenorrhea is defined as an absence of menstruation. Treatment depends on the etiology; therefore, it is initially necessary to determine whether it is primary or secondary amenorrhea. In adolescents without pubertal development, Turner's syndrome is the most common cause of primary amenorrhea. Hormonal studies will help determine the cause of secondary amenorrhea such as thyroid or pituitary disease or if it is related to eating disorders or a chronic disease. Dysmenorrhea is classified according to primary and secondary dysmenorrhea (or acquired). Primary dysmenorrhea occurs in >80% of all cases and, unlike secondary dysmenorrhea, is not associated with any abnormality such as endometriosis. The use of anti-inflammatory drugs is the treatment of choice for primary dysmenorrhea, whereas for secondary dysmenorrhea, treatment depends on the etiology.