$Unique_ID{BRK00190}
$Pretitle{Genitourinary System}
$Title{The Meaning of Teenage Abnormal Periods}
$Subject{periods teenager abnormal}
$Volume{J-14}
$Log{
Female Reproductive System*0006101.scf
Diseases of the Female Organs*0009001.scf
The Menstrual Cycle*0009101.scf}

Copyright (c) 1991   Tribune Media Services, Inc.


The Meaning of Teenage Abnormal Periods


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QUESTION:  My daughter won't discuss this with me openly, but I know she is
worried and anxious.  I need some information before I open the conversation
with her.  What does it mean when a teenager gets abnormal periods?

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ANSWER:  Irregular vaginal bleeding is fairly common in adolescents because
even though menstruation begins, it initially is not accompanied by ovulation
in almost 50% of all teenage girls.  Initially the bleeding occurs after
estrogen (a female hormone) causes a buildup or thickening in the endometrium
(the tissue which lines the uterus) which sheds and bleeds irregularly after a
few months because the endometrium cannot support the thick layer.  A
temporary reduction in estrogen levels can also cause the bleeding, as can a
lack of progesterone, the hormone responsible for ovulation.  Since a true
hormonal balance and the onset of ovulation frequently don't develop until
mid- or late puberty, menstrual irregularity can be quite common.
     However, in managing teenagers exhibiting such irregularities, it is
important to distinguish a normal variation from an actual abnormality.
Bleeding is usually labeled clinically abnormal when painless heavy bleeding
persists for over a week and occurs more frequently than at 21-day intervals.
These symptoms, as well as the development of secondary anemia due to large
losses of blood, should be investigated.
     To diagnose an abnormality, tests are performed to rule out other serious
causes such as congenital uterine abnormalities, cervical polyps, pelvic
inflammatory disease, or coagulation defects.  Once these and other possible
complications are eliminated, evaluation and treatment can be initiated.  In
nonemergency cases, when the girl is not actively bleeding and has a
hemoglobin count of ten or more grams, management is fairly simple.  The
patient is instructed to keep a menstrual calendar and is placed on a high
protein diet with adequate rest and recreation.  In some cases, oral iron
supplements are given.  Ultimately, the hope is that ovulation will develop
spontaneously and with it, regular and mildly painful periods.
     In emergency cases, when there is active bleeding and low hemoglobin,
treatment is more complicated.  Since progesterone is responsible for
ovulation, oral progestins or other synthetic progestogens are administered
with small amounts of estrogen.  One tablet taken four times a day after meals
should stop the bleeding within two days.  The dose should then be reduced to
one or two tablets for a couple of weeks.  Withdrawal bleeding follows.
     After this initial hormone treatment, the patient is given a low-dose
oral contraceptive for three to four months to prevent a recurrence.  Oral
contraceptives can be very effective in regulating cycles and after a few
months of treatment, patients will usually resume ovulation and regular
periods.  However, all patients who exhibit dysfunctional uterine bleeding
should receive continuous long-term observation because some may never ovulate
and will continue to experience recurrent clinical problems.
     Quite simply, none of this evaluation or treatment can start until you
and your daughter have a heart to heart, "sit-down" conversation.  Sure she's
worried, and maybe a bit frightened as well.  Remember your first experiences?
Once your passed the anxieties, and a little time has passed, it will all
probably straighten out by itself.  If not, a visit to the physician is then
in order.
ÿ
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
