Irregular menses in perimenarcheal girls—evaluate or wait? ▸

Irregular menses may warrant more detailed evaluation than is commonly performed. These authors retrospectively reviewed the charts of all girls aged 13 to 21 who presented to an inner-city clinic over a 3-year period; the 47 girls who reported irregular menses during the perimenarcheal period (i.e., within 3 years of menarche) were the focus of the study.

On physical examination, there were no significant findings in 39 girls; 3 had signs of functional ovarian hyperandrogenism (FOH), including obesity, hirsutism, acne, and ratios of luteinizing hormone to follicle-stimulating hormone (LH:FSH) >3, although pelvic ultrasound exams were normal. LH:FSH testing was performed in 4 of the 39 patients with normal physicals, 1 of whom had an abnormal ratio that suggested possible FOH. Other abnormal findings included microcytic, hypochromic anemia in three patients, and an elevated erythrocyte sedimentation rate in one patient. The authors suggest that menstrual irregularities in perimenarcheal girls who also have obesity, acne, or pallor are likely to have a treatable cause.

Comment ▸

Limitations of this study include its retrospective design, lack of a standardized protocol to systematically collect data, and possible selection bias (85% of subjects were Hispanic). However, the authors correctly remind us that thorough history taking and physical examination, coupled with laboratory assessment of select young women, can exclude other treatable underlying conditions. Although gynecologic immaturity is the leading cause of dysfunctional uterine bleeding in adolescents, even when ovulation does not occur gonadotropin levels decrease in response to increasing estrogen levels; as a result, most anovulatory cycles tend to be fairly regular, with limited bleeding. This fact of nature allows pediatricians to sagely counsel that a tincture …