Menstrual Problems During Adolescence
Iris F. Litt MD1
1 Associate Professor of Pediatrics, Director of Adolescent Medicine, Stanford University School of Medicine, Stanford, CA 94305
Medical interest in menstrual absence is antedated by that of the philosophers and theologians (Aristotle, Plato). The importance of menses induction in early medical teaching is underscored by the observation that 14% of all drugs listed by Dioscovides of Ana Zarbos in the first half of the second century AD were supposedly capable of inducing menses. It was, even in antiquity, recognized that cessation of menses was an early sign of pregnancy, yet amenorrhea was regarded as a systemic disease that required immediate intervention. Although there have been sizable gains in our understanding of amenorrhea, modernday physicians often face a comparable dilemma in approaching its differential diagnosis and determining a course of action. This article is written in order to simplify this process and, in so doing, to assist the pediatrician in dealing with the adolescent patient with amenorrhea, as well as other common menstrually related problems, such as menometrorrhagia and dysmenorrhea.
AMENORRHEA
In order to understand absence of menses, it is first necessary to visualize the mechanisms responsible for its presence. The first prerequisite for normal menses is presence of a functionally and anatomically intact cerebral-hypothalamic-pituitary-ovarian-uterine axis. This system is apparently capable of cyclic menses from birth, the reasons for its quiescence until puberty remaining an intriguing mystery.
