Teen Health

Menstrual Disorders in Adolescent Girls

Written by Dr. Ashwini Nanasaheb Talpe and medically reviewed by iCliniq medical review team.

Image: Menstrual Disorders in Adolescent Girls

Menstrual problems are common during adolescence due to slow maturation of the system situated in the brain called hypothalamo-pituitary axis. The hypothalamo-pituitary axis is the mediator of the menstrual cycle. The failure of this system may lead to variations in the menstrual cycle. It can last up to two to five years after menarche (first occurrence of menstruation). More than two-third of adolescent problems are related to menstruation in the forms such as dysmenorrhea (painful period), amenorrhea or oligomenorrhea (absent or reduced periods) and menorrhagia (abnormal uterine bleeding).


It is one of the common gynecological complaint during adolescence. About 60% of girls in the age of 12-17 years complain of dysmenorrhea. However, only 15% seek medical advice. First few periods are pain free due to absence of ovulation. A dragging pelvic pain is common. This is due to pelvic vascular engorgement under reflex of sex steroids. Dysmenorrhea may be primary or secondary.

Primary dysmenorrhea (spasmodic) develops early after uterus menarche, within the first two years. It is defined as painful menstrual cramps in the absence of clinically detected pelvic pathology. A possible diagnoses in the case of atypical severe pain are endocrinal, myometrial disturbed action, prostaglandins and vasopressin.

Secondary dysmenorrhea (congestive) may occur many years after menarche. The pain is usually more severe and precede menstruation by several days. Colicky pain before flow is relieved with menstruation. Common causes are endometriosis, pelvic inflammatory disease (PID), congenital genital tract malformation, cervical stenosis, cervical polyp, fibroid, intrauterine adhesion and IUCD (intrauterine contraceptive device).

Diagnosis of Dysmenorrhea:

  • Careful history is the key to diagnosis.
  • A pelvic examination is avoided in young girl who is not active sexually. In such cases genital per rectal examination can be done.
  • Pelvic ultrasound will help to diagnose conditions such as structural uterine defects, fibroid, endometriosis, PID and polyp.
  • Rarely diagnostic laparoscopy is needed in case of severe atypical pain.


Primary amenorrhea is when a girl does not start menstruation by the age of 16 years. Amenorrhea can be diagnosed with clinical history and examination. Also, we need to check thyroid tests, ultrasound, laparoscopy and prolactin levels. Causes of primary amenorrhea are as follows:

  1. CNS disorder like pituitary gland tumor, craniopharyngioma, stress and antidepressant drugs.
  2. Thyroid dysfunction.
  3. Adrenal dysfunction like Cushing syndrome and congenital adrenal hyperplasia.
  4. Ovarian dysfunction like premature ovarian failure and androgen secreting tumor.
  5. Outflow tract dysfunction like Scheuermann's syndrome, cervical or vaginal agenesis, imperforated hymen.
  6. Pregnancy.


Abnormal uterine bleeding is usually associated with anovulatory cycles. There are multiple reasons for anovulation.

  • Anovulation due to inappropriate maturation of HPA axis, PCOS (polycystic ovarian syndrome), stress, obesity and excessive exercise.
  • It can also be due to blood dyscrasias like sickle cell anemia and ITP (idiopathic thrombocytic purpura), infections like endometritis and cervicitis and systemic disorders like liver and kidney disease.
  • Anatomical lesions like polyp, foreign body, sexual abuse, fibroid and malignancy can result in anovulation.
  • Hypothalamic factors like eating disorder, stress and low body fat can give rise to menorrhagia.

The diagnosis of menorrhagia depends on thorough history, clinical examination, per abdominal and per vaginal examination, ultrasound and diagnostic hysterolaparoscopy.

For further information regarding adolescent menstrual problems, consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Last reviewed at: 07.Sep.2018



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