Chapter 7 – Abnormal Uterine Bleeding and Other Disorders of the Menstrual Cycle

Menstrual disorders in adolescents

Menstrual disorders are common in adolescence. Periods can be heavy, irregular or painful for the initial years following menarche. Serious pathology is rare.46 However menstrual disorders can have a significant impact on adolescents’ quality of life and result in school absences.(51)

Due to immaturity of the hypothalamic pituitary ovarian (HPO) axis in the first two years after menarche more than half of the menstrual cycles are anovulatory. With maturation of the HPO axis the cycles become regular. Dysfunction of the HPO axis and Müllerian anomalies may also be diagnosed in adolescents, these may present with delayed puberty and amenorrhoea.

Anovulatory cycles are often irregular and prolonged, which may result in anaemia.(50) Anovulatory cycles are typically not painful however infrequent periods and their associated heavier blood loss may result in dysmenorrhoea. With regular ovulatory cycles the periods often become painful due to the increased production of prostaglandins.(50)

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