Article Text

other Versions

The majority of irregular menstrual cycles in adolescence are ovulatory: results of a prospective study
  1. Alexia S Peña1,2,3,
  2. Dorota A Doherty4,
  3. Helen C Atkinson4,
  4. Martha Hickey5,
  5. Robert J Norman2,6,
  6. Roger Hart4
  1. 1Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
  2. 2Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
  3. 3Department of Endocrine and Diabetes, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
  4. 4School of Women’s and Infants' Health, Women and Infants Research Foundation, University of Western Australia, Perth, Western Australia, Australia
  5. 5Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
  6. 6Discipline of Obstetrics, University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Dr Alexia S Peña, Discipline of Paediatrics, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia; alexia.pena{at}


Purpose While ovulation is most likely to occur in adolescent girls with regular menstrual cycles, there are limited data on the incidence of ovulation in girls with irregular menstrual cycles in early postmenarcheal years. The aim of the study was to evaluate the presence of ovulation in healthy postmenarcheal girls with irregular menstrual cycles.

Methods, design and subjects Prospective cohort study over 12 weeks including 40 healthy postmenarcheal girls recruited from the population-based cohort of adolescents from Western Australian Pregnancy Cohort (Raine) Study with irregular menstrual cycles defined by either menstrual cycles <21 days or >35 days in duration or cycle length that varied from month to month by >4 days according to menstrual diaries.

Main outcome measure Ovulation defined by urinary pregnanediol-3α–glucuronide/creatinine measurements higher than three times above minimum value obtained from 12 samples (1 per week).

Results Forty girls (37 Caucasians) with irregular menstrual cycles aged 15.1 (median (IQR) 14.9–15.4) years who were 2.3 (1.9–3.3) years postmenarche were assessed. Urinary pregnanediol-3α–glucuronide/creatinine values identified that 33 girls (82.5%) ovulated during the 3 months of observation and 7 girls had anovulatory cycles. Menstrual diaries collected for a median (IQR) of 159 (137.5–188.2) days showed median minimal and maximum menstrual cycle duration of 24 (11.5–29) and 38.5 (35–48) days, respectively.

Conclusions A large proportion of healthy adolescent girls with irregular menstrual cycles are still ovulating despite irregular and infrequent menses.

  • adolescent health
  • ovulation
  • Raine study
  • urinary pregnanediol

Statistics from


  • Contributors ASP analysed and interpreted the data, did the first drafting of the article as well as critical revisions. Both RH and ASP are the guarantors of this work and as such, have full access to all the data in the study and take responsibility for the integrity of the data. DAD performed analysis of the data and critical revision of the manuscript. HCA performed all measurements of the main outcome of the study (urine pregnanediol-3α-glucuronide) and critically reviewed the manuscript. MH collected data for the study. MH, RJN and RH obtain funding for the study, contributed to drafting of the article and critically reviewed the manuscript. All authors approved the final version of this manuscript.

  • Funding This work was supported by the Australian National Health and Medical Research Council (Project GrantNo. APP403968) and Centre for Research Excellence scheme (APP1078444). Thestudy funders did not have any role in study design, collection, analysis andinterpretation of data.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles