Question of the Week
For January 5, 2016
Your answer is correct.
Obtain an abdominal ultrasound Ask the patient to keep a menstrual cycle diary Test levels of thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, prolactin, and testosterone Measure hematocrit, platelet count, and von Willebrand factor Perform a bimanual examination
Key Learning Point View Case Presentation
In the first postmenarchal year, the most common cause of irregular menstrual bleeding is anovulatory cycles.
In the first postmenarchal year, the most common cause of irregular menstrual bleeding in an otherwise healthy adolescent girl is anovulatory cycles, because the hypothalamic–pituitary–ovarian axis feedback loops are not yet mature. Most menstrual cycles range from 21 to 45 days, last 7 days or fewer, and require three to six sanitary pads or tampons per 24-hour interval.
Irregular menses can be associated with a variety of medical conditions, including pregnancy, endocrinopathies, hormone-producing tumors, uterine and ovarian disorders, infection, trauma, bleeding disorders, medications, excessive exercise, and eating disorders. Therefore, patients who demonstrate the following menstrual cycle abnormalities should undergo further workup:
- The development of markedly irregular periods after establishment of regular monthly periods
- Amenorrhea lasting >90 days
- Periods lasting >7 days
- Heavy periods requiring frequent pad or tampon changes (soaking through more than one pad or tampon every 1 to 2 hours)
Further workup — including a bimanual examination, laboratory evaluation, and imaging — is unnecessary in a healthy adolescent girl who reports irregular bleeding but has a normal physical examination and none of the above-described menstrual abnormalities.
Last reviewed Jun 2018. Last modified Feb 2015.
American Academy of Pediatrics Committee on Adolescence. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics 2006 Nov; 118:2245. > View Abstract
Gray SH. Menstrual disorders. Pediatr Rev 2013 Jan 3; 34:6. > View Abstract