7 - Menstrual problems in teenagers

Summary

Problems with heavy or painful menstruation are the most common reasons for seeing a teenager at a gynaecological clinic. It is extremely important when assessing an adolescent with a complaint of abnormal menstruation that a careful history is taken and that some time is spent trying to make an objective assessment of the degree of the problem. It is well appreciated among gynaecologists how difficult it is to do this in adults and it can be more difficult in adolescents, who have fewer criteria against which to measure the degree of their menstrual loss. Failure to do this and to opt for treatment of what is essentially a normal cycle will confirm the girl in her belief that her menstruation is abnormal, with resultant problems in later years. One study, which is rather old now (1966), found a high proportion of girls with adolescent menstrual problems having hysterectomy performed in their early 20s. The mother's fears and expectations also have to be dealt with. The scenario ‘I had problems with my periods when I was her age and I ended up having a hysterectomy before I was 30 and my daughter is going the same way’ is a well-recognised one which requires sensitive handling. It is important for the girl to understand that she is not necessarily going to have the same problems as her mother.