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  • Title: Menstruation and its disorders in adolescence.
    Author: Greydanus DE, McAnarney ER.
    Journal: Curr Probl Pediatr; 1982 Aug; 12(10):1-61. PubMed ID: 6764754.
    Abstract:
    This monograph has presented a review of menstrual disorders in adolescents. It has been emphasized that health care professionals who deal with youths should consider a comprehensive approach that places the youth with a menstrual problem within the framework of her adolescent and pubertal development. Thus, a discussion of psychologic growth as well as important aspects of puberty were presented. A thorough medical history and carefully done pelvic examination remain the basis for any evaluation of these young women even in this age of rapidly-advancing medical technology. Many of the menstrual dysfunction problems are related to the sequential, physiologic events of puberty and can be effectively handled by the well-trained general clinician. Specific, complex situations should be referred to the appropriate specialist, preferably someone with an understanding of adolescence. Three basic types of menstrual disorders have been considered: dysmenorrhea, dysfunctional uterine bleeding and amenorrhea. Our conclusion is that there is much the general clinician can do for the adolescent who presents with menstrual dysfunction. This paper reviews the common disorders of menstruation during adolescence in the context of pubertal and psychological development and suggests a practical approach to their evaluation and management by clinicians. The cornerstone of the evaluation of teenagers with possible menstrual pathology is a careful history and physical examination. The history should detail major pubertal events such as thelarche, pubarche, height spurt, and menarche. Use of a medical questionnaire is helpful, and this can be used as a teaching instrument. Since coital activity is a common cause or influencing factor in many adolescent menstrual problems, this area should not be ignored. The clinician can use the physical examination to encourage the adolescent to be aware of her body and its normal changes. The 1st pelvic examination is best performed by a well trained generalist who has established rapport with the patient rather than by a gynecologist. Dysmenorrhea, dysfunctional uterine bleeding, and amenorrhea are the 3 most common menstrual disorders among adolescents. Physicians should not be influenced by previous attitudes that women who complain of severe menstrual pain are overreacting to such stimuli. In cases where primary dysmenorrhea does not respond to basic analgesics, estrogen therapy, oral contraceptives, and prostaglandin synthetase inhibitors have been utilized. These drugs should be used judiciously, with careful consideration of their side effects. A major cause of secondary dysmenorrhea is pelvic inflammatory disease, and early treatment is critical to prevent complications. Endometriosis should be suspected in teenagers who present with progressive dysmenorrhea, severe dyspareunia, or irregular vaginal bleeding of unknown etiology. Abnormal bleeding paterns often reflect anovulatory menstrual cycles. It takes an average of 20 months from menarche to the establishment of a regular menstrual pattern. Therapy of anovulatory uterine bleeding involves both a plan to stop the acute bleeding and another plan to regulate the menstrual period in the future. The basic method of regulation is to raise the estrogen and/or progesterone levels. If regular periods do not develop within 3 years of menarche, consultation with a gynecologist should be sought. Primary amenorrhea can result from physiologic delay, Mayer-Rokitansky or Turner's syndrome, or chronic illness, whereas secondary amenorrhea is commonly caused by pregnancy, weight loss, polycystic ovary disease, or nutritional disturbances.
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