Skip to main content Accessibility help
×
Home
  • Print publication year: 2014
  • Online publication date: June 2014

10 - Delayed menarche

Summary

Excessive menstrual bleeding describes the clinical problems of heavy menstrual blood loss together with frequent or irregular menstruation. This chapter addresses endometrial morphology, the mechanism of menstruation and the aetiology and management of menstrual problems. A very common cause relates to ovulatory dysfunction, which typically leads to a combination of irregular bleeding and a variable volume of menstrual flow, which can lead to heavy menstrual bleeding (HMB). Clotting disorders such as von Willebrand's disease are another cause of HMB. Reduced clotting is a known feature at the time of menstruation. Pelvic pathologies such as fibroids are common, affecting between 20 and 25% of women. It is reported that around a third of women with fibroids complain of heavy menstrual blood loss. There are a number of terminologies to describe menstrual complaints such as menorrhagia, polymenorrhoea, oligomenorrhoea, polymenorrhagia and metrorrhagia.

Related content

Powered by UNSILO

References

1. GluckmanPD, HansonMA. Evolution, development and timing of puberty. Trends Endocrinol Metab 2006;17:7–12.
2. ParentAS, TeilmannG, JuulA, SkakkebaekNE, ToppariJ, BourguignonJP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003;24:668–93.
3. MishraGD, CooperR, TomSE, KuhD. Early life circumstances and their impact on menarche and menopause. Womens Health (Lond Engl) 2009;5:175–90.
4. GüntherAL, Karaolis-DanckertN, KrokeA, RemerT, BuykenAE. Dietary protein intake throughout childhood is associated with the timing of puberty. J Nutr 2010;140:565–71.
5. MorrisDH, JonesME, SchoemakerMJ, AshworthA, SwerdlowAJ. Determinants of age at menarche in the UK: analyses from the Breakthrough Generations Study. Br J Cancer 2010;103:1760–4.
6. Thein-NissenbaumJM, CarrKE. Female athlete triad syndrome in the high school athlete. Phys Ther Sport 2011;12:108–16.
7. GladenBC, RaganNB, RoganWJ. Pubertal growth and development and prenatal and lactational exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene. J Pediatr 2000;136:490–6.
8. BlanckHM, MarcusM, TolbertPE, et al. Age at menarche and tanner stage in girls exposed in utero and postnatally to polybrominated biphenyl. Epidemiology 2000;11:641–7.
9. HickeyM, BalenA. Menstrual disorders in adolescence: investigation and management. Hum Reprod Update 2003;9:493–504.
10. PeacockA, AlviNS, MushtaqT. Period problems: disorders of menstruation in adolescents. Arch Dis Child 2012;97:554–60.
11. Wiksten-AlmströmerM, HirschbergAL, HagenfeldtK. Prospective follow-up of menstrual disorders in adolescence and prognostic factors. Acta Obstet Gynecol Scand 2008;87:1162–8.