Menstrual Abnormalities In Adolescent Girls
Abnormal bleeding due to hormones and sexually transmitted diseases are quite common in this age group
Adolescent girls achieve puberty and they start having menstruation as a part of their pubertal development. But almost 75 per cent of adolescent girls have painful periods or dysmenorrhea. Other abnormalities of menstruation are classified as Abnormal Uterine Bleeding (AUB).
On an average 80m1 of menstrual blood is lost and bleeding usually lasts for five-seven days. If bleeding is more than 80 ml or associated with the passage of clots or duration of bleeding is more than seven days, it ¡s an indication of abnormal menstrual flow.
Dysmenorrhea or painful periods are of two types, primary or secondary. In primary dysmenorrhea, there is no gynaeco$ogical cause for painful periods and it’s idiopathic. It also subsides with simple analgesics. But in secondary dysmenorrhea, there is a cause for painful periods and it has to be treated. The most common cause for secondary dysmenorrhea in teens is endometriosis and among the other causes are adenomyosis, fiborids and ovarian cysts.
Abnormal Uterine Bleeding (AUB) Can Present As:
- Absence of periods or amenorrhea
- Excessive bleeding or menorrhagia
- Bleeding in between periods
- Irregular bleeding
Amenorrhea or absence of periods can be primary or secondary. Primary amenorrhea is defined as absence of periods till 15 years of age in a girl who has developed secondary sexual characters or non-development of secondary sexual characters till the age of 13 years. Secondary amenorrhea is defined as absence of menstruation for six months once the girl has started menstwating.
Menstrual abnormalities such as abnormal bleeding due to bleeding disorders such as coagulation disorders like protein C, protein S deficiency, Von Willebrand disease, hemophilia, sickle cell disease are more common in adolescent age group as these disorders start manifesting when they start menstruation. Abnormal bleeding due to hormones and sexually transmitted diseases are also more common in this age group.
Discerning What Is Abnormal
It is also very important to distinguish menstrual abnormality from normal physiological changes. When girls start menstruating, their periods may be irregular for first two years as the hypothalamo-pituitary axis maturation may take two years for the cycles to be regular. In the initial years, ovulation is irregular, so it’s pretty common for young girls to have irregular cycles.
Thus these aspects must be kept in mind, when a young girl presents with irregular periods and before diagnosing her as suffering from hormonal imbalance, such as polycystic ovarian disease (PCQD), ovarian tumours or some other abnormality.
Causes Of Menstrual Disorders In Adolescents
- Anatomic defects such as MRKH (Mayer- Rokítansky-Kuster-Hauser) syndrome, Impertorate hymen, transverse vaginal septum
- Hypogonadism such as gonadal dysgenesis (Turner syndrome, Swyer Syndrome) and gonadal agenesis
- Hypothalamic causes such as diet, stress and psychological eating disorders
- Pituitary causes such as prolactinomas and other hormone-producing tumours
- Endocrine disorders
- Other causes such as constitutional delay, PCOS
Abnormal Uterine Bleeding (AUB)
- Immaturity of HPO (Hypothalamic Pituitary-Ovarian Axis)
- Pregnancy , PCOS
- Functional hypothalamic dysfunction
Abnormal Uterine Bleeding – Heavy Menstrual Bleeding (HMB)
- Structural abnormalities such as fibroids, adenomyosis
- Systemic bleeding disorders such as Von Willebrand disease, platelet deficiency, factor deficiencies, amongst the most common causes. intermenstrual Bleeding
- Sexually transmitted diseases
- Hormonal causes such as use of oral contraceptives
These problems in teens can be identified by a thorough history and physical examination. Painful periods or primary dysmenorrhea is identified when teens complain of painful periods and on physical examination, there is no significant abnormality detected.
Thus, an ultrasound should be conducted to rule out secondary causes of dysmenorrheal such as endometriosis, pelvic inflammatory disease, fibroids, and other pelvic pathologies. Also, to rule out abnormal uterine bleeding, some additional tests may have to be undergone, apart from a routine physical examination and ultrasound, such as thyroid function test, hormonal evaluation such as FSH and LH, prolactin, androgens, STI laboratory testing, pregnancy test, CBC (Complete Blood Count) and specific coagulation factors, if systemic coagulation defect is suspected.
After excluding medical disorders, painful periods are treated with analgesics. Abnormal uterine bleeding or heavy menstrual bleeding can be treated with oral contraceptive pills or progesterone. For irregular bleeding such as in cases of PCOS too, oral contraceptives can be used. But for specific causes such as f ibroids, endometriosis and STI’s, specific treatment is required.