Menstrual disorders

Abstract

The presence of normal menses in young women should be considered a vital sign; heavy, painful, absent, or irregular menses should be investigated. (Based on some research evidence as well as consensus.) (1)(2) • Patients who are pregnant usually present with secondary amenorrhea but may present with irregular or heavy menstrual bleeding. A sensitive urine pregnancy test should be performed early in the evaluation of these complaints, j regardless of stated sexual history. (Based on expert opinion.) • Menstrual complaints such as heavy bleeding and dysmenorrhea are a frequent cause of school absence in girls and should be evaluated and treated. (Based on some research evidence as well as consensus.) (1)(2) • Polycystic ovary syndrome (PCOS) is a frequent cause of secondary amenorrhea or oligomenorrhea but also can present with anovulatory and frequent menses. (Based on expert opinion.) • Functional hypothalamic amenorrhea is associated commonly with stress, weight change, chronic illness, and intense athletic activity. Patients with eating disorders have an energy deficit, as do many of those experiencing intense athletic activity, and are at risk for hypothalamic amenorrhea. • The morbidity associated with prolonged amenorrhea is low bone density due to inadequate estrogen production. Use of oral contraceptives (OCPs) alone appears not to restore bone density in girls with anorexia nervosa. The best recommendation is increased energy intake and weight gain when underweight. (Based on some research evidence as well as consensus.) (6) • Young women with special health-care needs need assessment and counseling about sexuality and reproductive health. Clinicians should be aware of how cognitive or mobility issues affect menstrual hygiene and should present options for medical management of menses to improve quality of life. (Based on expert opinion.) (10).