• adolescent health
• paediatric practice
• physiology
• fertility

For many members of the community, menstruation remains one of the few remaining human mysteries and is the subject of myth and misinformation. As fertility and childbirth continue to be intrinsic to human survival, understanding the menstrual cycle is of pivotal importance.

Many subjects in clinical medicine have been the victim of beliefs profoundly held and with little basis other than an expert opinion. In recent years, expansion of technology, better understanding of physiology and the genetic basis of many disorders have provided hitherto impossible insights into mechanisms of disease. These changes have allowed new interventions with reduced morbidity and better health outcomes. Progress through puberty with established menstruation is considered to reflect a reasonable standard of general health in girls. The paper by Pena and associates describes patterns of ovulation and thus expectation of fertility in adolescent girls with irregular menstruation, demonstrating that most cycles are ovulatory, contrary to accepted beliefs.

In some countries, the discipline of paediatrics still ends at age 12, in others it is 15–16 years and for a majority transition takes place either at age 18 or at the end of secondary schooling. Despite variations in the age of transition for many medical conditions, in institutions that care for increasingly complex conditions of childhood, concerns have even been raised that some …