Menstrual Disorders in Adolescent Girls

Adolescence is the time when there is sudden transformation in the body and many questions arises in the minds of the adolescents. Firstly they are not able to cope with the changes and secondly the changes bring along problems with them. The most challenging problems are related to menses, in girls. Menstrual conditions are many that may require physician’s attention or any other healthcare professional’s attention. The most common of the menstrual disorders are premenstrual syndrome, dysmenorrheal and amenorrhea.

Before the onset of the menses, females face many uncomfortable symptoms which last for a short period, stretching from few hours to few days. But some of them can be very intense and can disturb the normal functioning of the person. These symptoms are grouped as premenstrual syndrome. In usual cases, the symptoms come to a halt when the menses begin, but for some they may last even after the menstrual periods are over. Eighty five percent of the females experience some of the symptoms of premenstrual syndrome at one time or the other. Nearly forty percent experience the symptoms so intensely that their daily chores are affected by it and ten percent are disabled by it.

There are many premenstrual syndrome symptoms which can be broadly classified as neurologic & vascular symptoms, psychological symptoms, gastrointestinal symptoms, fluid retention, eye problems and respiratory problems. The cause of premenstrual syndrome are fluctuations in the levels of progesterone & estrogen, hypoglycemia, hyperprolactinemia, psychogenic factors, changes in carbohydrate metabolism, excessive aldosterone, progesterone allergy and water retention by kidneys. The good thing is that premenstrual syndrome can be prevented by exercising regularly, eating balanced diet and sleeping adequately.

Dysmenorrhea is feeling intense menstrual pain and cramps. Depending on the severity, dysmenorrhea is stated as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea symptoms are felt from the onset of the menstrual periods and are felt life-long. Because of abnormal uterine contractions due to chemical imbalance, severe menstrual cramping is experienced. Secondary dysmenorrhea starts in the later stages. The causes are different for primary and secondary dysmenorrhea. Secondary dysmenorrhea can be blamed on medical conditions such as endometriosis, uterine fibroids, pelvic inflammatory disease, tumors, infections, and abnormal pregnancy.

Dysmenorrhea symptoms are lower abdomen cramping & pain, lower back pain, nausea, diarrhea, vomiting, fatigue, fainting, weakness and headaches. Females who are overweight, smoke, and have started to menstruate before turning eleven are at a higher risk of developing dysmenorrheal. Females who drink alcohol during menstrual period experience prolonged pain. After studying the health conditions, age, cause of dysmenorrhea, and extent of condition of the individual, corresponding treatment will be recommended. Regular exercise, abdominal massage, hot bath, vitamin supplements, and dietary modifications can help overcome dysmenorrhea.

Amenorrhea is the condition in which the female skips her menses for more than three consecutive menstrual cycles. Amenorrhea is also classified as primary amenorrhea and secondary amenorrhea. Primary amenorrhea develops from the onset of menstrual periods. In this condition, the adolescent might not get periods when she enters puberty. Secondary amenorrhea is a condition where periods become irregular after a period of time and not from the start.

There are many causes of amenorrhea such as ovulation abnormality, eating disorders, birth defects, anatomical abnormalities, malnourishment, anorexia, bulimia, pregnancy, over exercising, thyroid disorder, obesity and other medical conditions. Out of these ovulation abnormalities are a common cause for absent or irregular periods. It is a must that an adolescent start getting menses at least by the age of sixteen. If not, anatomical abnormality, birth defect and other medical conditions are the cause. Adolescents who participate in sports actively and are athletic have a lower body fat content because of which they have absent menses. Even because of malnourishment, the body is incapable of sustaining pregnancy. So in turn the body itself shuts down the reproductive system and menses. Extra fat cells in the body interfere with ovulation and that is the reason why obese female have irregular menses. Amenorrhea is treated by dietary modifications, ovulation inhibitors and hormone treatment.

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Tests and Examinations for Adolescent Girls

Adolescence is the time when girls face many changes as they not only become physically mature, but sexually, too. In order to maintain good health, they need to consult gynecologist, adolescent medicine physician and obstetrician. Adolescents who are sexually active need to get some test done like pelvic examination, Pap test and test for checking sexually transmitted diseases. This helps the early determination of conditions that can affect reproductive, gynecological and sexual health.


Schiller test is conducted where the iodine solution is used to cover the cervix. In colposcopy, colposcope is used to check the cervix and the vagina. Cancer is checked by biopsy. In this a small quantity of cervical tissue is removed and a pathologist checks the tissue for abnormal cells.


The most important test is the Pap test or a pap smear. The cells from the mouth of the womb or the cervix are collected to check for cancer, abnormal cells, infection or inflammation. The detection of abnormalities shows signs of cancer. Therefore it is recommended that every female must take Pap test regularly to check out for invasive cancers in the early stages itself. And if invasive cancer is detected, it can be successfully treated in the early stages. Apart from detecting invasive cancer, other changes, such as cancer cells or dysplasia and inflammation, of the vagina and cervix can also be determined. Inflammation can be caused by pregnancy, abortion, miscarriage, hormones, trichomoniasis infections, viruses, bacteria, yeast infections, and other medication.


The repetition Pap test will be suggested by the gynecologist. When a girl becomes sexually active, she will have to test for cervical cancer after three years of becoming active because it usually takes many years for the significant development of cancer or abnormality. Usually there are some cervical cell changes and transient human papilloma virus infections or HPV infections which are very common. Therefore, a Pap test for cervical cancer is recommended every three years. But women who are under thirty years are at a higher risk of getting HPV infections of higher risk. It would be more feasible if every individual takes advice from her doctor about when she can begin screening, the frequency of the test to be taken, and when she can discontinue the tests.


In a Pap test, if abnormal cells are determined, usually more tests are recommended to detect abnormalities which will require treatment. Abnormal Pap test will be handled differently for adolescents when compared to adults. Usually the low grade cervical lesions will not require any treatment and will go away on their own. That is the reason why the Pap test is repeated after a gap of six to twelve months, after the original Pap test which identifies abnormalities. But this repetition will vary from individual to individual depending on her health status and kind of abnormalities found.


A replacement of the Pap test is thinprep test. It involves new technique for testing cells from the cervix for abnormalities. But the cost of getting a thinprep test done is double the cost of getting Pap test done. The advantage of getting a thinprep test is that it requires to be re-done less number of times and detects lesions in initial stages itself. The cervical cells, instead of getting smeared on a slide, are introduced into a liquid vial. After the filtration of the liquid, the cells from the cervix are examined by being placed on the slide.

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