Menstrual problems including
amenorrhea,
oligomenorrhea, irregular cycles, abnormal
uterine bleeding or
dysmenorrhea represent 50% of adolescents' gynecologic complaints. Irregular and anovulatory cycles are common during the first postmenarcheal years and may reflect a normal transient step of ovarian
hyperandrogenism, but they may also result from hormonal abnormalities affecting the adrenals, the ovaries or the pituitary.
Amenorrhea may be a sign of late puberty or of a problem affecting the hypothalamus, the pituitary or the ovaries. Evaluation includes a complete physical examination, basal hormonal determinations of the hypothalamic-pituitary-ovarian function, of the thyroid, of the
androgens and of the nutritional and growth parameters. This first evaluation must be completed by a karyotype analysis in case of primary
amenorrhea or by the measurements of free
testosterone, androstanediol
glucuronide and
testosterone glucuronide in case of
hirsutism, and may be followed by X-rays, echography or dynamic tests depending on the first results.
Therapy will always be directed towards the etiology of the disease. Abnormal
uterine bleeding is generally the result of anovulatory cycles and responds to hormonal
therapy, but a systemic illness, a local pathology or a complicated pregnancy must always be excluded. In case of
dysmenorrhea,
endometriosis must be excluded. Simple
dysmenorrhea is generally suppressed by antiprostaglandins.