Teens are faced with many problems as they attain puberty and continue to grow and develop. Menstrual irregularities are a common cause for adolescent girls to seek medical advice and the help of a gynaecologist.
While a normal menstrual cycle means getting regular period, this means you have your period roughly every 28 days but this could defer by a few days and still be normal. On average you lose about 30 – 50 ml of blood monthly during your period as well. While the amount of blood loss is subjective, there are ways of measuring blood loss by how many pads or tampons you use during a cycle.
An abnormal menstrual cycle can be common in adolescent girls and are most commonly seen after the onset of menstruation, the phase called menarche.
While it normally does not need extensive investigating, in extreme cases it is advised that you seek a doctor’s help who would perform an Ultra Sound Scan [USS] of the abdomen and pelvis to rule out any underlying problem.
Abnormalities in menstruation may include any of the following:
1.Quantity
Excessive amount of blood loss, during your menstruation, is known as “menorrhagia”. Excessive blood loss may result in iron deficiency/anaemia if not treated properly.
2.Timing or Frequency
The menstrual cycle may be too frequent where there is more than one period per calendar month or it may be infrequent.
3.Duration of Bleeding
During a menstrual cycle, the normal duration of bleeding is 3 – 7 days. Prolonged duration of bleeding, with a regular menstrual cycle, is also known as “menorrhagia”.
4.Pain
Lower abdominal pain during menstruation is not uncommon. Pain during periods is called “dysmenorrhea”. Often, the pain may be sufficiently severe and cause you to miss school frequently. The pain often starts at the onset of periods and may last for 24 – 48 hours. It is also associated with nausea, vomiting, back ache and pain in the thighs.
5.Regularity
Menstruation is a cyclical process that commonly takes place once every month. Yet, some women might experience irregular cycles.
6.Time of Onset
Menarche or the first menstrual period quite early in life, before the age of 8 years is termed “precocious puberty”. While the absence of menstruation or “primary amenorrhoea” up to the age of 16 years is called “delayed puberty”.
1.OLIGOMENORRHOEA
WHAT IS IT?
Infrequent menstruation that occurs at intervals of 35 days or more. Women who suffer from this condition have between 4 to 9 menstrual cycles a year andmenstrual flow during a period may be light or heavy.Irregular or infrequent menstruation is a result of involuntary menstrual cycles and are common soon after the onset of menstruation. But they also may be a manifestation of obesity or low body weight.
DIAGNOSIS
An Ultra Sound Scan [US Scan] of the abdomen would usually reveal any underlying cause.
TREATMENT
Infrequent menstruation during adolescence is usually normal and does not warrant further investigation, unless the symptoms persist for over a year.
2.DYSMENORRHOEA
WHAT IS IT?
This is excessive menstrual pain that could interfere with your daily activities. There are also two types of dysmenorrhoea; Secondary Dysmenorrhoea occurs when there is an underlying disease, disorder or a structural abnormality either within or outside the uterus, and Primary Dysmenorrhoea is diagnosed in the absence of the above.
DIAGNOSIS
An Ultra Sound Scan [US Scan] of the abdomen would usually reveal any underlying cause.Secondary dysmenorrhoea may warrant laparoscopy to rule out any pelvic problem.
TREATMENT
First line of treatment is with Mefenemic acid which is an agent that prevents the production of prostaglandins, chemicals that mediate pain during menstruation.If the pain does not respond to mefenemic acid, the next line of treatment should be withCombined Oral Contraceptive Pills [COCP] which reduce pain as well as alleviate the symptoms of Pre Menstrual Syndrome or PMS.
3.MENORRHAGIA
WHAT IS IT?
This is when the menstrual cycleis regular, but there is excessive bleeding or the duration of bleeding is prolonged.If this is untreated especially due to the excessive nature of the blood loss, women may become anaemic.
DIAGNOSIS
An Ultra Sound Scan [US Scan] of the abdomen would usually reveal any underlying cause.
TREATMENT
Mefenemic acid is the first line of treatment.
[This is an anti-prostaglandin agent that prevents the production of prostaglandins, chemicals that deter the uterus from contracting and stopping heavy menstrual flow during menstruation.]
If the blood loss does not reduce with Mefenemic acid, the next line of treatment should be with Tranexamic acid.
[An anti-fibrinolytic, it helps stabilize blood clots and reduce blood loss.]
Both Mefenemic acid and Tranexamic acid are often used in combination to effectively reduce heavy menstrual bleeding.
Norethisterone is the third line of treatment.
[A progesterone analong, Norethisterone helps maintain the inner lining of the uterus in a steady state thereby reducing blood loss. This is often used if the combination of Mefenemic acid/Tranexamic acid is ineffective.]
4.AMENORRHOEA
WHAT IS IT?
Amenorrhoea falls into two categories. Primary amenorrhoea is the absence of menstruation. The girl has never menstruated before. The presence or absence of secondary sexual characteristics is vital and would help in the diagnosis. Secondary amenorrhoea is the absence of menstruation for 6 months or more.
DIAGNOSIS
This is the absence of menstruation till 16 years, with the presence of secondary sexual characteristics such as pubic& armpit hair and development of breasts. It requires further investigations by a Gynaecologist
An Ultra Sound Scan [US Scan] of the abdomen would usually reveal any underlying cause such as Poly Cystic Ovarian Disease, which can cause secondary amenorrhoea.
TREATMENT
Treatment varies depending on the investigation and diagnoses.
5.PRECOCIOUS PUBERTY
WHAT IS IT?
Essentially this is when puberty occurs at an unusually early stage.
DIAGNOSIS
It is essential to seek the advice of a Gynaecologist.
TREATMENT
Treatment varies depending on the investigation and diagnoses.