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- Paula K. Braverman, MD*
- Steven J. Sondheimer, MD†
- *Associate Professor of Pediatrics, Temple University School of Medicine; Director, Adolescent Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA.
- †Professor of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, and Director of Family Planning, Hospital of the University of Pennsylvania Medical Center, Philadelphia, PA.
IMPORTANT POINTS
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The median age of menarche in the United States is 12.77 years.
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Ninety percent of females achieve menarche by the time they reach Tanner stage 4 breast and pubic hair development.
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A lack of pubertal development by age 13 years warrants investigation.
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Turner syndrome is characterized by short stature, webbed neck, widely spaced nipples, shield chest, high arched palate, congenital heart disease, renal anomalies, and autoimmune disorders.
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Polycystic ovary syndrome is the most common cause of persistent irregular menses.
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Primary dysmenorrhea is caused by prostaglandins; secondary dysmenorrhea is associated with pelvic pathology.
Introduction
One of the major milestones during pubertal development in females is menarche. Although most adolescent women pass through this transition with relative ease, menstrual disorders such as amenorrhea, dysfunctional uterine bleeding, and dysmenorrhea are common complaints that present to the primary care physician.
Menarche and The Menstrual Cycle in Adolescents
The median age of menarche in this country, according to the National Health Examination Survey, is 12.77 years, with African-American females reaching menarche a few months before Caucasian females. Although almost 90% of females have achieved menarche by the time they reach Tanner stage 4 breast and pubic hair development, there is a mean of slightly more than 2 years (range, 0.5 to 5.75 years) between the onset of breast development and menarche. The normal menstrual cycle lasts between 21 and 35 days (mode, 28), with fewer than 0.5% of women having cycles shorter than 21 days and fewer than 1% having cycles lasting more than 35 days. Most women bleed for 3 to 7 days and experience approximately 30 to 40 mL of blood loss. Cycles lasting 8 to 10 days and/or having more than 80 mL of blood loss are considered abnormal. Estimating the number of soaked pads or tampons used during a 24-hour period sometimes is helpful in determining the amount of …
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