Abstract

Adolescent gynaecology focuses on a unique subset of gynecologic disorders among younger females which should be approached differently to adults:

Dysfunctional Uterine Bleeding (DUB)

DUB refers to endometrial bleeding that is prolonged, excessive or irregular, and not attributed to an anatomic lesion of the uterus. The most common causes are anovulation- immaturity of the hypothalamic—pituitary—ovarian (HPO) axis and underlying bleeding disorders. The evaluation of menorrhagia should begin with a detailed menstrual history and physical examination. Treatment should be started according to the haemoglobin value of the patient. Hormonal treatment is the most effective therapy to stop and control the bleeding. Oestrogen provides hemostasis and progesterone stabilises the endometrium. Monophasic pills containing at least 30—35 µg of ethinyl estradiol should be used initially and can be given once daily in the adolescent who is not actively bleeding. If there is heavier or active bleeding an OCP taper can be used.

Primary Dysmenorrhea (PD)

Dysmenorrhea refers to recurrent abdominal pain that occurs during menstruation and can be divided into primary causes: absence of any pelvic pathology or secondary causes: underlying pelvic pathology. PD generally does not occur until ovulatory menstrual cycles are established. PD is caused by excess production of endometrial prostaglandin which causes dysrhythmic uterine contractions, hypercontractility, and increased uterine muscle tone leading to uterine ischemia. History is the most important part of differentiating primary and secondary dysmenorrhea. Nonsteroidal antiinflammatory drugs are considered the first line of therapy. Combination oral contraceptive pills can be given to patients who fail to respond to or cannot tolerate NSAIDs.

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) frequently becomes manifest during adolescence, and is primarily characterised by ovulatory dysfunction and hyperandrogenism. PCOS should be considered in any adolescent girl with a chief complaint of menstrual irregularity, cutaneous signs of hyperandrogenism, obesity and insulin resistance. One of the most important differences from a diagnosis in adults is that PCO on ultrasound is not a criterion. Recognising and treating PCOS in adolescents is important for management of the symptoms of hyperandrogenism and abnormal menses. First-line treatment is life-style changes, control of obesity and combination oral contraceptive pills, since these correct both menstrual abnormalities and hyperandrogenemia.