Adolescent menstrual health

Attention to pubertal development and menstrual health is an important aspect of primary care for adolescents. Textbooks may not provide sufficient evidence-based guidance to facilitate the early detection of gynecologic disease states and conditions. Conversely, the typical guidelines for pubertal development may lead to over-evaluation of normal girls. Chaotically irregular and unpredictable bleeding is NOT the norm during adolescence. On the contrary, although many early menstrual cycles are anovulatory, most adolescents have menstrual cycles that fall within the parameters of 21-45 days. Adolescents with menstrual bleeding that is less frequent than every 45 days, is prolonged > 7 days, or is excessively heavy should be evaluated in order to detect conditions such as eating disorders, polycystic ovary syndrome, and von Willebrand disease. Clinicians who attend to adolescent menstrual cycles can help set the stage for future health.     

Gynecologic health care for the adolescent solid organ transplant recipient

The improved survival of pediatric recipients of solid organ transplants has prompted increased attention to quality of life issues. These include attainment of normal growth, involvement in romantic relationships, and the desire to control fertility. As an increasing number of adolescent transplant recipients are involved in normal social and sexual relationships, they require careful attention to their gynecologic and reproductive health care needs. Anticipating the onset of sexual activity before it occurs may help to prevent a mistimed pregnancy by providing or prescribing condoms and emergency contraception in advance. In addition, many transplant recipients can safely use the currently available methods of hormonal contraception provided there is careful attention to organ function, other medical problems, and concurrently prescribed medications. In adolescent patients, issues such as pubertal development and menstruation, contraception, and routine gynecologic health care are typically addressed by the patient's primary care provider. However, the complexity of the adolescent transplant recipient's medical care necessitates close collaboration among all health care providers caring for the patient. This review is intended to help the transplant team better understand the gynecologic health care needs and treatment options of their adolescent patients.     

Gynecologic issues of the adolescent female solid organ transplant recipient

Advances in the field of transplant medicine are providing adolescent recipients with continual improvements in health and quality of life. With expanding opportunities for normal social and sexual relationships, adolescents require careful attention to their gynecologic and reproductive health (Box 1). Medical considerations vary depending on the type of organ transplanted, underlying and comorbid conditions, and current medication use. Most adolescent girls achieve menarche, however, and irregular cycles should be evaluated and managed with the same considerations applied to healthy young women. The management of menstrual disorders frequently uses hormonal contraceptive methods. Many transplant recipients also are sexually active and require a contraceptive method to prevent a mistimed pregnancy. With careful attention to organ function, other medical problems, and concurrently prescribed medications, many transplant recipients can use safely the currently available methods of hormonal contraception.     

Health perspectives regarding adolescents in military service

PURPOSE OF REVIEW: Our purpose is to illuminate health perspectives of adolescents in military service, who comprise the main bulk of military personnel. RECENT FINDINGS: Two views are emphasized: the soldier as a developing adolescent and the healthcare of adolescent soldiers. The capacity for abstract thinking and future planning, characteristic of late adolescence, opposes the military challenges of obedience, disengagement from the family, and potential threats for physical injury and mental stress, in addition to the requirement for responsibility beyond the individual's personal needs. On the other hand, at discharge from military service, the mature young adult faces questions of a 17-year-old adolescent. Health perspectives regarding adolescents in military service include physical and mental health screening before draft; recruiting adolescents with chronic illnesses; specific healthcare issues during service, including routine medical care, psychosocial problems of young people in service and approach to suicide and to risk behaviors; health aspects of adolescent women in military frameworks; and the dual commitment of physicians as military officers. SUMMARY: Professionals who care for the well-being of young people in their late teens and early 20s in military service need to consider the service period as an additional developmental stage within late adolescence that requires attention as part of the comprehensive healthcare.     

Adolescent Contraception in the Emergency Department: Abnormal Uterine Bleeding and Beyond

The emergency department (ED) is a frequent and important site for gynecologic care, and many women present to the ED for reproductive health concerns such as abnormal menses. Due to early menstrual age and increased incidence of sexually transmitted infections, adolescents are particularly prone to abnormal menses, but are also disproportionately affected by unintended pregnancy. While EDs have long been used for the evaluation and initial management of abnormal uterine bleeding, general contraceptive provision in the ED is a novel approach to addressing unmet contraceptive needs among adolescent women. We review normal menstruation and the evaluation and management of abnormal uterine bleeding in adolescents, including the use of combined oral contraceptives. Expanding on this established indication for contraceptive use in the ED, we present attitudes, barriers, and approaches to ED provision of contraceptives for adolescent pregnancy prevention.     

Perspectives of Urban Adolescent Black Males and Their Parents on Well Care

ObjectiveAdolescents have fewer well-care visits than all other age groups. Males and ethnic minorities are seen least often. We elicited from Black adolescent males and their parents key drivers of teen well-care seeking.MethodsWe conducted separate semistructured interviews with Black adolescent males and their parents. We recruited parent-teen dyads from West Philadelphia. Eligible teens were age 13 to 18, with no complex chronic health conditions. We purposively sampled teens who had not received preventive care in at least 2 years, some of whom had since returned to care and some not. Interviews were recorded, transcribed, and coded by 2 coders using the constant comparative method, resolving discrepancies by consensus. Interviews continued until thematic saturation.ResultsWe interviewed 23 Black adolescent males (mean age 15) and 22 parents (20 mothers). Participants understood that teens should routinely receive preventive care. Four themes emerged: receiving preventive care is important to knowing teens are mentally and physically well; remembering to schedule/attend visits is challenging - participants find appointment reminders helpful; mothers noted that males of all ages are generally disengaged from health care; teens and parents felt that a “good” parent ensures teens receive preventive care.ConclusionsBlack adolescent males and their parents value regular preventive care as an opportunity to ensure the teen is physically and mentally well, but competing priorities interfere with care receipt. Results support testing the impact of reminders on receipt of care in this population. These reminders may be most effective if directed at mothers and focused on “good parenting.”     

Menstrual Disorders and Menstrual Hygiene Practices in Higher Secondary School Girls

Objective

To study the menstrual problems and menstrual hygiene practices of adolescent girls in Thiruvananthapuram City Corporation.

Methods

Students of class XI and XII in the age group 15–19 years, belonging to ten Higher Secondary Schools within the Thiruvananthapuram City Corporation area were selected for the study by multistage sampling procedure and screened using a pretested self evaluation questionnaire.

Results

Menstrual disorders were reported in 21.1%. The most frequently reported problem during menstruation was dysmenorrhoea (72.4%) followed by oligomenorrhoea (11.3%). Only 11.5% of the girls who had menstrual problems sought treatment and majority from a gynecologist. Out of 81.5% girls who reported vaginal discharge, only 5.7% had abnormal discharge. Menstrual hygiene was adequate in the majority of girls.

Conclusions

Menstrual disorders are common in adolescence and can have significant consequences on future reproductive health.

     

The adolescent and young adult with Klinefelter syndrome:ensuring successful transitions to adulthood

As many adolescent and young adult males with Klinefelter syndrome move into young adulthood, they will require long-term medical and mental health care for their complex and specific health care needs. Adult general medical providers and endocrinologists may feel ill-prepared to meet the medical needs of this population. In turn, many pediatric primary care and subspecialty providers may find themselves struggling to determine how best to transition the older adolescent to adult-oriented services. Working with families and their teens to consider and address current and future medical, mental health, educational and vocational needs will enhance that young adult's independence and functioning. This chapter addresses general transition issues and those that are specific to adolescents with Klinefelter syndrome. The prognosis for these young patients is good, and can be further enhanced by supportive families and a medical team that is informed about how best to facilitate the transition to adult-oriented services.     

Urban-rural differences in menstrual problems and practices of girl students in Nagpur,India

Menstruation in adolescent girls is often associated with menstruation related problems and poor practices. The study was planned to investigate the menstrual related problems and menstrual practices among school going adolescent girls. The study was a community based cross sectional study in a girls’ school in Nagpur. Majority of menstrual practices were significantly better in urban girls as compared to rural girls (P<0.05). Majority of the girls (71.83%) had at least one problem related to menstrual cycles. There was a significant difference in proportion of menstrual problems in rural and urban girls (P<0.01). Menstrual problems are a common source of morbidity in this population.     

The effects of obesity on the menstrual cycle

The prevalence of childhood and adolescent obesity has significantly increased in the United States and worldwide since the 1970s, a trend that has been accelerated by the COVID-19 pandemic. The complications of obesity range from negative effects on the cardiovascular, endocrine, hepatobiliary, and musculoskeletal systems to higher rates of mental health conditions such as depression and eating disorders among affected individuals. Among adolescent girls, childhood obesity has been associated with the earlier onset of puberty and menarche, which can result in negative psychosocial consequences, as well as adverse effects on physical health in adulthood. The hormones leptin, kisspeptin and insulin, and their actions on the hypothalamic-pituitary-ovarian axis, have been implicated in the relationship between childhood obesity and the earlier onset of puberty. Obesity in adolescence is also associated with greater menstrual cycle irregularity and the polycystic ovary syndrome (PCOS), which can result in infrequent or absent menstrual periods, and heavy menstrual bleeding. Hyperandrogenism, higher testosterone and fasting insulin levels, and lower levels of sex hormone-binding globulin, similar to the laboratory findings seen in patients with PCOS, are also seen in individuals with obesity, and help to explain the overlap in phenotype between patients with obesity and those with PCOS. Finally, obesity has been associated with higher rates of premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder, and dysmenorrhea, although the data on dysmenorrhea appears to be mixed. Discussing healthy lifestyle changes and identifying and managing menstrual abnormalities in adolescents with obesity are key to reducing the obstetric and gynecologic complications of obesity in adulthood, including infertility, pregnancy complications, and endometrial cancer.     

Sex and sexual health: A survey of Canadian youth and mothers

INTRODUCTION

Apparent changes in adolescent sexual behaviours have led to debate in recent years. A survey on adolescent sexuality was designed to determine mainstream Canadian adolescents’ current knowledge and sources of sexual health information, to identify their needs, and to understand the perceptions and the role of parents in sexual health education.

METHODOLOGY

In October 2005, on-line interviews were conducted by Ipsos Reid (Ipsos Canada) with 1171 Canadian teenagers (14 to 17 years of age) and 1139 mothers of teenagers.

RESULTS

Twenty-seven per cent of teens were sexually active at a mean age of 15 years, with an average of 2.5 lifetime partners, and had been in their current relationship for longer than eight months. The last time that they had had sex, 76% had used a condom. Teens and mothers overestimated the percentages of teens sexually active at any age. Most valuable sources of information were school, parents, friends and doctors. Sixty-nine per cent of teens could not find the information that they were looking for, and 62% reported obstacles in getting information. Teens lacked knowledge about sexually transmitted infections and their consequences. Seventy-five per cent of mothers believed that their teenagers’ friends were significant role models when it came to sexuality, and 50% mentioned entertainment celebrities at par with them. However, 45% of teenagers regarded their parents as their role models, far ahead of friends (32%) and entertainment celebrities (15%). Despite saying that they had positive relationships with their mothers, 38% of teens had not discussed sexuality with them. Most teens trusted the information given by health professionals (94%) and believed that it was their role to provide sexual health information.

CONCLUSIONS

Most adolescents are responsible when it comes to sexuality, but there are still areas of concern. Adolescents identify barriers to getting information and lack knowledge about sexually transmitted infections. Parents should feel more comfortable when it comes to discussing sexuality, especially the more value-based issues. Health care professionals and teachers have a role to play, and should ensure that teens are getting correct information. It is important to have diverse sources of information. All teens are not ready at the same time to receive the information; thus, it should be repeated. Governments, health, education and public health authorities have an essential role to play to make sexual health information accurate, accessible, inclusive and salient to the reality of Canadian adolescents.     

Developmentally informed research on the effectiveness of clinical trials: a primer for assessing how developmental issues may influence treatment responses among adolescents with alcohol use problems

The goal of this article is to familiarize readers with the adolescent developmental issues and processes most likely to affect responses to treatment for alcohol use problems. Although the need for research that blends developmental science and treatment outcome research is widely acknowledged, scant information exists about developmentally informed approaches to treatment research with alcohol-abusing teens. Exactly how developmental issues may influence treatment responses among adolescents with alcohol use problems remains an open question. In the hope of moving developmentally informed research forward, this article reports findings from a literature review regarding the degree to which developmental issues and processes have been considered in adolescent alcohol treatment research. Moreover, promising concepts and methods from applied developmental science are discussed, as are various developmental processes and transitions that may influence adolescent risk behavior. Finally, guidance is provided regarding how applied developmental science conceptualizations and methods may be incorporated successfully into randomized, clinical trials with adolescents with alcohol use problems.     

Update of nutrition guidelines for the teen: trends and concerns

Sociocultural influences are known to affect adolescent eating patterns and behaviors. Some teens reject a meat-based diet to become vegetarians; others take up dieting to lose weight or develop an eating disorder. Teens require increased nutrients to provide for the accelerated growth that takes place during these years. Nutritional deficiencies in adolescence can lead to loss of height, osteoporosis, and delayed sexual maturation. Sports also play an important role in many teens' lives. The desire to excel can lead to increased training and prolonged periods of dieting. Disordered eating, amenorrhea, and osteoporosis describe the "female athlete triad." Although more frequently seen in girls, boys who participate in sports that have an emphasis on size and weight such as wrestling and body building are also at risk for subclinical eating disorders. This paper discusses issues surrounding restrictive and nonrestrictive food patterns of adolescents and their nutritional consequences.     

Meeting the health care needs of suburban youth: review of a clinical service

The demographic and medical data from the first 1,000 patients registered at a suburban adolescent health service were reviewed and the findings compared with the results of an initial survey performed in the same community and other health services located in urban communities. Most of the patients were white (92%), girls (82%), and 16 to 18 years of age (63%) and had parents who graduated from high school (59%) or college (28%). They reported higher rates of participation in health-risk behaviors, including smoking (50%), drinking (60%), drug use (67%), and sexual intercourse (83%), than their peers. Seventy-two percent of the patients sought medical attention for sexuality-related or gynecologic concerns, including contraception (39%), pregnancy determination (20%), and evaluation of possible sexually transmitted disease (9%), and 28% sought attention for general medical or emotional needs, including checkups or immunizations (11%), nutritional or weight problems (4%), and emotional issues or substance abuse (4%). Management of sexuality-related issues differed from that reported in urban settings, whereas laboratory screening tests indicated that problems were similar to those in other settings. Many problems described in an initial survey of youth in the community were not seen at the adolescent health service. We conclude that a suburban-based health service may meet certain health care needs of the higher risk youth of the community but that ultimate care for adolescents remains with the private physicians in this setting.     

Risks associated with alcohol-positive status among adolescents in the emergency department: a matched case-control study.

OBJECTIVE: The purpose of this study was to examine alcohol use, alcohol-related problems, other risk-taking behaviors, and parental monitoring in adolescents who tested positive for alcohol in an emergency department.Study design: A matched case-control design was implemented for adolescents presenting to a pediatric emergency department who were screened for alcohol use. An alcohol-positive sample (N = 150) was compared with a matched alcohol-negative sample (N = 150) for alcohol use, alcohol problems, depression, smoking, risk-taking behavior, and parental monitoring. RESULTS: The alcohol-positive group reported significantly higher drinking frequency, drinking problems, prior alcohol-related injuries, and episodes of driving after drinking and riding with a drinking driver than the alcohol-negative adolescents. The same pattern was true for depressed mood, reckless behaviors, poor grades in school, and daily smoking. The parents of alcohol-positive teens reported their teens had come home intoxicated more often than parents of alcohol-negative teens. There were no differences between parent groups in monitoring of teens. CONCLUSION: Adolescents who test positive for alcohol in an emergency department are a high-risk group who meet the criteria for indicated prevention. Screening for alcohol abuse is recommended.     

Adolescent girls,the menstrual cycle,and bone health

In adolescent girls, amenorrhea is sometimes viewed as a variant of normal; in fact, however, during the first gynecologic year, the 95th percentile for cycle length is 90 days. Although early menstrual cycles are frequently anovulatory and may be somewhat irregular, girls with menses coming less frequently than every 90 days may have significant pathology associated with hypoestrogenism. Hypoestrogenism is a known risk factor for the development of osteoporosis. Causes of oligomenorrhea and amenorrhea include the relatively common conditions of hyperandrogenism, eating disorders, and exercise-induced amenorrhea, as well as uncommon conditions such as pituitary tumor, gonadal dysgenesis, and premature ovarian failure. Even functional hypothalamic oligomenorrhea has been linked to reduced bone density. Attention to menstrual irregularity and the earlier diagnosis of conditions causing it may lead to interventions that will benefit life-long bone health.     

Gynecological exam of the adolescent girl: clinical and methodological approach

The gynaecological approach with the adolescent is always complex, arduous and also stimulating. It is necessary to acquire specific knowledge, to understand that the adolescent is always searching for his identity and that the most important request is that the normality. The first impact is fundamental, understanding the non verbal language, giving importance to the words used during the consultation and imposing a correct anamnesis which must become a type of psychotherapy and must search not for the "defects" but for the "resources" which are available to the patient and on the basis of these build our therapeutic programme. It is essential to understand the menstrual problems which will be so important in the future maturing phase of the adolescent. Finally the instrumental approach must be as little invasive as possible and to be able to understand the adolescentís solitude better it is necessary to create a good relationship with the patient.     

Mental health worries, communication, and needs in the year of the U.S. terrorist attack: national KySS survey findings.

INTRODUCTION: To reduce the escalating rate of mental health/psychosocial morbidities in children and adolescents, NAPNAP initiated a new national campaign entitled Keep your children/yourself Safe and Secure (KySS). The objective of the first phase of this campaign was to conduct a national survey to assess the mental health knowledge, attitudes, worries, communication, and needs for intervention of children/teens, parents, and pediatric health care providers. This first report from the KySS survey describes the child/teen and parental findings. METHODS: A cross-section of 621 children/teens and 603 of their parents from 24 states completed the KySS survey during visits to their primary health care providers. RESULTS: The five greatest worries of both children/teens and their parents included knowing how to cope with stressful things in their lives, anxiety, depression, parent-child relationships, and problems with self-esteem. The majority of children/teens and their parents reported that they do not talk to their primary care providers about these issues. Participants expressed a multitude of needs and suggestions regarding how to better recognize, prevent, and deal with mental health problems. CONCLUSION: Opportunities must be created for children/teens and their parents to communicate their mental health worries and needs to each other and to their pediatric primary care providers to facilitate earlier diagnosis and treatment of mental health problems. Interventions are urgently needed to assist children and teens in coping with the multitude of stressors related to growing up in today's society.     

Menstrual disorders in the college age female

College-age young women frequently experience a variety of menstrual-related complaints, including dysmenorrheal, menorrhagia, irregular menses, and menstrual-related mood changes. These problems deserve careful evaluation; they may reflect normal ovulatory menstrual symptoms or be suggestive of significant pathology that can have a major impact on future reproductive and general health. The menstrual cycle is a vital sign whose normalcy suggests an overall good health and whose abnormality requires evaluation. Eating disorders and the female athlete triad increase the risk of osteoporosis; polycystic ovary syndrome is associated with future cardiovascular risks. Diagnosis and management of these problems will not only improve a young woman's current health, sense of well-being, and overall quality of life but may also lower her risks for future disease and ill-health. This article addresses normal menstrual function, excessive bleeding, infrequent or absent menses, pain with menses, menstrual-related mood disorders, and recommendations about routine gynecologic examinations and evaluation.     

Adolescent male health

Although adolescent males have as many health issues and concerns as adolescent females, they are much less likely to be seen in a clinical setting. This is related to both individual factors and the health care system itself, which is not always encouraging and set up to provide comprehensive male health care. Working with adolescent boys involves gaining the knowledge and skills to address concerns such as puberty and sexuality, substance use, violence, risk-taking behaviours and mental health issues. The ability to engage the young male patient is critical, and the professional must be comfortable in initiating conversation about a wide array of topics with the teen boy, who may be reluctant to discuss his concerns. It is important to take every opportunity with adolescent boys to talk about issues beyond the presenting complain, and let them know about confidential care. The physician can educate teens about the importance of regular checkups, and that they are welcome to contact the physician if they are experiencing any concerns about their health or well-being. Parents of preadolescent and adolescent boys should be educated on the value of regular health maintenance visits for their sons beginning in their early teen years.