Menstrual disorders are common in adolescent girls. Periods can be irregular, heavy and/or painful, especially in the first few years following menarche. Serious pathology is rare; however, menstrual dysfunction can have a significant effect on daily activities and result in school absence. There are many treatment options which are safe to use in adolescents, although the evidence for their use is extrapolated from adult data. We present a clinical review of the current practice, including management of girls with other medical problems and learning difficulties.

Keywords:
Menorrhagia, Dysmenorrhoea, Irregular periods
1.
Parker M, Sneddon A, Arbon P: The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG 2010;117:185–192.
2.
Boswell HB: The adolescent with menorrhagia: why, who and how to evaluate for a bleeding disorder. J Pediatr Adolesc Gynecol 2011;24:228–230.
3.
Venturoli S, Porcu E, Fabbri R, Pluccinetta V, Ruggeri S, Macrelli S, Paradisi R, Flamigni C: Longitudinal change of sonographic ovarian aspects and endocrine parameters in irregular cycles of adolescence. Paediatr Res 1995;38:974–980.
4.
Sanguin S, Lanta-Delmas S, Le Blanche A, Grardel-Chambenoit E, Merviel P, Gondry J, Fauvet R: Uterine arteriovenous malformations: diagnosis and treatment in 2011. Gynecol Obstet Fertil 2011;39:722–727.
5.
Stavroulis AI, Saridogan E, Creighton SM, Cutner AS: Laparoscopic treatment of endometriosis in teenagers. Eur J Obstet Gynecol Reprod Biol 2006;125:248–250.
6.
Laufer MR, Goitein L, Bush M, Cramer DW, Emans SJ: Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol 1997;10:199–202.
7.
National Institute for Health and Clinical Excellence: Heavy Menstrual Bleeding (NICE Clinical Guideline 44). 2007. http://www.nice.org.uk/nicemedia/live/11002/30401/30401.pdf.
8.
Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkilä A, Walker JJ, Cameron IT: Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. BJOG 1998;105:592–598.
9.
Lethaby A, Irvine G, Cameron I: Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev 2008;CD001016.
10.
British National Formulary 2012. 6.4.1.2 Progestogens. http://www.medicinescomplete.com/mc/bnf/current/4336.htm#_4336.2.
11.
Rajput R, Dhuan J, Agarwal S, Gahlaut PS: Central venous sinus thrombosis in a young woman taking norethindrone acetate for dysfunctional uterine bleeding: case report and review of literature. J Obstet Gynaecol Can 2008;30:680–683.
12.
Lapecorella M, Orecchioni A, Dell’Orso L, Mariani G: Upper extremity deep vein thrombosis after suspension of progesterone-only oral treatment. Blood Coagul Fibrinolysis 2007;18:513–517.
13.
Lidegaard O, Lokkegaard E, Svendsen AL, Agger CA: Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ 2009;339:b2890.
14.
Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Contraception 1998;57:315–324.
15.
British National Formulary for Children 2011–2012, pp 377–379.
16.
Kovacs G: Progestogen-only pills and bleeding disturbances. Hum Reprod 1996;11:20–23.
17.
British National Formulary for Children 2011–2012, pp 403–404.
18.
Fraser IS, McCarron G: Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia. Aust NZ J Obstet Gynaecol 1991;31:66–70.
19.
Hendrix SL, Alexander NK: Primary dysmenorrhoea treatment with a desogestrel-containing low-dose oral contraceptive. Contraception 2002;66:393–399.
20.
Collaborative Group on Epidemiological Studies of Ovarian Cancer: Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet 2008;371:303–314.
21.
Jick SS, Walker AA, Jick H: Oral contraceptives and endometrial cancer. Obstet Gynecol 1993;82:931–935.
22.
Fernandez E, La Vecchia C, Balducci A, Chatenoud L, Franceschi S, Negri E: Oral contraceptives and colorectal cancer risk: a meta-analysis. Br J Cancer 2001;84:722–727.
23.
Gallo MF, Lopez LM, Grimes DA, Schulz KF, Helmerhorst FM: Combination contraceptives: effects on weight. Cochrane Database Syst Rev 2011;CD003987.
24.
Dinger JC, Heinemann LAJ, Kuhl-Habichl D: The safety of drospirenone-containing oral contraceptive: final results from the European Active Surveillance study on oral contraceptives based on 142,475 women-years of observation. Contraception 2007;75:344–354.
25.
Jick H, Kaye JA, Vasilakis-Scaramozza C, Jick SS: Risk of venous thromboembolism among users of third generation oral contraceptives compared with users of oral contraceptives with levonorgestrel before and after 1995: cohort and case-control analysis. BMJ 2000;321:1190–1195.
26.
Medicines and Healthcare Products Regulatory Agency: Current Key Information on the Combined Oral Contraceptive, Yasmin – May 2011. Safety Warnings and Messages for Medicines. 2011. http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON117560.
27.
Gallo MF, Nanda K, Grimes DA, Lopez LM, Schulz KF: 20 µg versus >20 µg estrogen combined oral contraceptives for contraception. Cochrane Database Syst Rev 2011; CD003989.
28.
Faculty of Sexual and Reproductive Healthcare: UK Medical Eligibility Criteria for Contraceptive Use. 2009. http://www.fsrh.org/pdfs/UKMEC2009.pdf.
29.
Vandenbroucke JP, Koster T, Briet E, Reitsma PH, Bertina RM, Rosendaal FR: Increased risk of venous thrombosis in oral contraceptive users who are carriers of factor V Leiden mutation. Lancet 1994;344:1453–1457.
30.
Baillargeon JP, McClish DK, Essah PA, Nestler JE: Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab 2005;90:3863–3870.
31.
World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception: Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study. Lancet 1996;346:505–510.
32.
Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T: Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009;339:b3914.
33.
Curtis KM, Mohllajee AP, Martins SL, Peterson HB: Combined oral contraceptive use among women with hypertension: a systematic review. Contraception 2006;73:179–188.
34.
Faculty of Sexual and Reproductive Healthcare: Clinical Guideline. Combined Hormonal Contraception. October 2011. http://www.fsrh.org/pdfs/CEUGuidanceCombinedHormonalContraception.pdf.
35.
Collaborative Group on Hormonal Factors in Breast Cancer: Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 1996;347:1713–1727.
36.
Gaffield ME, Culwell KR, Ravi A: Oral contraceptives and family history of breast cancer. Contraception 2009;80:372–380.
37.
Sabers A, Buchholt JM, Uldall P, Hansen EL: Lamotrigine plasma levels reduced by oral contraceptives. Epilepsy Res 2001;47:151–154.
38.
British National Formulary for Children 2011–2012, pp 396–402.
39.
Lethaby A, Farquhar C, Cooke I: Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev 2009;CD000249.
40.
Bonnar J, Sheppard BL: Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid and tranexamic acid. BMJ 1996;313:579–582.
41.
Sundström A, Seaman H, Kieler H, Alfredsson L: The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case-control study using the General Practice Research Database. BJOG 2009;116:91–97.
42.
British National Formulary for Children 2011–2012, p 123.
44.
Nilsson CG, Lähteenmäki PLA, Luukkainen T: Ovarian function in amenorrheic and menstruating users of a levonorgestrel-releasing intrauterine device. Fertil Steril 1984;41:52–55.
45.
Faculty of Sexual and Reproductive Healthcare: Clinical Guideline. Contraceptive Choices for Young People. March 2010. http://www.fsrh.org/pdfs/ceuGuidanceYoungPeople2010.pdf.
46.
National Institute for Health and Clinical Excellence (NICE): Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception. 2005. http://www.nice.org.uk/pdf/CG030fullguideline.pdf.
47.
Stewart A, Cummins C, Gold L, et al: The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. BJOG 2001;108:74–86.
48.
Crosignani PG, Vercellini P, Mosconi P, Oldani S, Cortesi I, De Giorgi O: A levonorgestrel-releasing intrauterine device versus hysteroscopic endometrial resection in the treatment of dysfunctional uterine bleeding. Obstet Gynecol 1997;90:257–263.
49.
Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R: Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril 2001;75:485–488.
50.
Vercellini P, Frontino G, De Giorgi O, Aimi G, Zaina B, Crosignani PG: Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril 2003;80:305–309.
51.
British National Formulary for Children 2011–2012, p 406.
52.
Faculty of Sexual and Reproductive Healthcare: Clinical Guideline. Progestogen-Only Injectable Contraception. November 2008. http://www.fsrh.org/pdfs/CEUGuidanceProgestogenOnlyInjectables09.pdf.
53.
Gordon CM, Pitts SAB: Approach to the Adolescent Requesting Contraception. J Clin Endocrinol Metab 2012;97:9–15.
54.
Lara-Torre E, Edwards CP, Perlman S, Hertweck SP: Bone mineral density in adolescent females using depot medroxyprogesterone acetate. J Pediatr Adolesc Gynecol 2004;17:17–21.
55.
Zacharin MR: Puberty, contraception and hormonal management for young people with disabilities. Clin Pediatr 2009;48:149–155.
57.
Zacharin M, Savasi I, Grover S: The impact of menstruation in adolescents with disabilities related to cerebral palsy. Arch Dis Child 2010;95:526–530.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.