Menstrual Disorders in Adolescence

• anatomical abnormalities
• birth defects
• pregnancy
• specific medical conditions.

Once a girl has started menstruating, reasons that she may develop amenorrhea may include:

• Eating disorders: Anorexia or bulimia can contribute to amenorrhea. When body weight is too low to sustain a pregnancy, the reproductive system will shut down. This state generally reflects a severely malnourished individual.
• Obesity: Although many people are aware that a very low bodyweight can interfere with a healthy menstrual cycle, they may not be aware that too high a bodyweight also has an effect on periods. An excess of fat cells can interfere with normal ovulation and lead to amenorrhea.
• Strenuous exercise: Adolescent athletes often begin their periods later in life than non-athletes. The non-stop strain and physical demands of competitive training and sports can lead to such a low fat content that bodies are not able to menstruate.
• Thyroid disorder: Hypothyroidism (underactive thyroid gland) or hyperthyroidism (overactive thyroid gland) can lead to menstrual cessation.

Polycystic Ovary Syndrome

Too few periods may point to a mild hormonal imbalance called Polycystic Ovary Syndrome (PCOS). Symptoms of PCOS include acne, excessive hair growth and weight problems. If left untreated, PCOS can cause infertility.

Dysmenorrhea

Painful periods, or dysmenorrhea, are another common complaint among adolescents. Usually symptoms can be treated with over-the-counter medications (such as acetaminophen and ibuprofen) and heating pads. If cramps are severe or prolonged, doctors may prescribe birth control pills or other medications.

Pre-Menstrual Syndrome (PMS)

One of the most common menstrual disorders in adolescence is PMS. Generally characterized by an array of physical and emotional symptoms that begin about a week before menstruation begins, PMS can be a very difficult condition. Girls may experience:

• anxiety
• breast tenderness
• depression
• fatigue
• headaches
• mood swings
• nausea
• weight gain.

PMS can often be handled with a healthy diet and exercise, but parents of adolescent girls should not hesitate to discuss concerning symptoms with their daughters' physicians (and encourage their daughters to do the same). Mild antidepressants are sometimes indicated in more severe cases.

Evaluation and Diagnosis

Diagnosis of the adolescent with menstrual irregularities will consist of obtaining a detailed medical history, growth chart reviews, general physical examination (the doctor will look for acne and excessive hair growth to rule out PCOS), a gynecological assessment (with possible ultrasound) and blood tests (to check hormone levels).

Treatment

Treatment of menstrual disorders in teens will vary depending on the problem and its underlying cause. Sometimes, just observation and the passage of time will result in normal periods. Other situations might require hormone replacement therapy (progesterone or oral contraceptives).

Parents and adolescents should keep in mind that problems in this age group are common. Adolescence can be a tough time in general, and girls may feel especially self-conscious or uncomfortable if they are also dealing with menstrual disorders. Parents should help their daughters to take an assertive role. Explain that it is healthy to openly speak with a doctor. Support is key, and girls should remember that most people will experience menstrual abnormalities at some time during their reproductive years.

Resources

Children's Hospital Boston (2006). Menstrual/Reproductive Disorder. Retrieved June 30, 2007, from the Children's Hospital Boston Web site: http://www.childrenshospital.org/az/Site1293/mainpageS1293P0.html.

Lucile Packard Children's Hospital (2007). Adolescent Medicine: Menstrual Disorders. Retrieved June 30, 2007, from the Lucile Packard Children's Hospital Web site: http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/adolescent/mensthub.html.

NCBI (n.d.). Adolescent Menstrual Disorders. Retrieved June 30, 2007, from the NCBI Web site: http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve