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Chapter 5 - Adolescent Menstrual Dysfunction

Published online by Cambridge University Press:  28 January 2023

Naomi S. Crouch
St Michael's Hospital, Bristol
Cara E. Williams
Liverpool Women's Hospital
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Menstrual disorders such as irregular, heavy or painful periods are common in adolescent girls and may affect quality of life, disrupt sports and social activities and are known to cause school absences in one in four girls. Immaturity of the hypothalamo–pituitary–ovarian (HPO) axis in post-menarchal years is the leading cause for menstrual dysfunction and visits to the emergency department in this age group [1]. Several terminologies have been used to describe menstrual dysfunction, but the International Federation of Gynaecology and Obstetrics (FIGO) system, describing normal and abnormal uterine bleeding (AUB) is the most universally preferred classification [2].

Publisher: Cambridge University Press
Print publication year: 2023

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Smith, Y, Quint, EH, Hertzberg, B. Menorrhagia in adolescents requiring hospitalization. J Pediatr Adolesc Gynecol. 1998;11:1315.CrossRefGoogle ScholarPubMed
Munro, MG, Critchley, HOD, Fraser, IS. FIGO Menstrual Disorders Committee: the two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393408.CrossRefGoogle Scholar
Morris, DH, Jones, ME, Schoemaker, MJ, Ashworth, A, Swerdlow, A. Secular trends in age at menarche in women in the UK born 1908–93: results from the Breakthrough Generations Study. Paediatr Perinatal Epidemiol. 2011;25:394400.CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynaecologists. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion 651. 2015.Google Scholar
Lavin, M, Aguila, S, Dalton, N, Nolan, M, Byrne, M, Ryan, K et al. Significant gynecological bleeding in women with low Von Willebrand factor levels. Blood Adv. 2018;2(14):1784–91.CrossRefGoogle ScholarPubMed
Jacobson, AE, Vesely, SK, Koch, T, Campbell, J, O’Brien, SH. Patterns of Von Willebrand disease screening in girls and adolescents with heavy menstrual bleeding. Obstet Gynecol. 2018;131(6):1121–9.CrossRefGoogle ScholarPubMed
Williams, C, Creighton, S. Menstrual disorders in adolescents: review of current practice. Horm Res Paediatr. 2012;78:135–43.CrossRefGoogle ScholarPubMed
Maybin, JA, Critchley, HOD. Medical management of heavy menstrual bleeding. Womens Health (Lond). 2016;12(1):2734.CrossRefGoogle ScholarPubMed
Mansour, D. Safer prescribing of therapeutic norethisterone for women at risk of venous thromboembolism. J Family Plann Reprod Health Care. 2012;38:148–9.Google ScholarPubMed
Lethaby, A, Wise, MR, Weterings, MAJ, Bofil Rodriquez, M, Broen, J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;11(2):CD000154.Google Scholar
Ackerman, K, Singhal, V, Baskaran, C, Slattery, M, Campoverde Reyes, KJ, Toth, A, et al. Oestrogen replacement improves bone mineral density in oligo-amenorrhoeic athletes: a randomised clinical trial. Br J Sports Med. 2019;53(4):229–36.CrossRefGoogle ScholarPubMed
Mehta, J, Thompson, B, Kling, JM. The female athlete triad: it takes a team. Cleve Clin J Med. 2018;85(4):313–20.CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynaecologists. Menstrual manipulation for adolescents with physical and developmental disabilities. Committee Opinion 668. 2016.Google Scholar
Meirow, D, Rabinovici, J, Katz, D, Or R, Shufaro Y, Ben-Yehuda D. Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer. 2006;107:1634.CrossRefGoogle ScholarPubMed
Hickey, M, Balen, A. Menstrual disorders in adolescence: investigation and management. Hum Reprod Update. 2003;9(5):493504.CrossRefGoogle ScholarPubMed

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