Phase of transition from childhood to adulthood
Constitute about one fifth of India’s population
Adolescents constitute a diversified group- School vs college going, married vs unmarried, educated vs uneducated, rural vs urban, different cast/ religion/ localities.
Broadly important problems of adolescents are :–
DEFINITION :- Any change in the :
Frequency of menstruation (24 – 35)
Duration of flow (4 – 7 days) or
Amount of blood loss (5- 80 ml)
Traditional terms describing abnormalities of menstrual bleeding:-
Amenorrhea – absent menses
Oligomenorrhea – infrequent menses, occurring at intervals > 35 days
Polymenorrhea – frequent menses, occurring at intervals < 24 days
Metrorrhagia – menses occurring at irregular intervals
Menorrhagia or hypermenorrhea – abnormally long or heavy menses, lasting > 7 days or involving blood loss > 80 ml
Causes :- ovulatory dysfunction ( hypothalamic- pituitary- ovarian axis )
– pregnancy related complications
– bleeding diathesis ( thrombocytopenia, von Willebrand disease or leukemia )
– stress (psychogenic, exercise induced )
Management : oral hematinics to correct anemia, hemostatics (tranexamic acid), weight reduction if obese, hormones 9 cyclic progestrones, OCPs), treating underlying cause
Dysmenorrhea is primary when it occurs in the absence of co-existent pelvic pathology. It is due to excessive levels of prostaglandins (hormone ) which stimulates uterine contractions and vasoconstriction (the constriction/narrowing of the blood vessels) which potentiate myometrial (the middle layer of the uterus) ischemia (inadequate blood supply) causing pain.
Age at onset : 16–25 yrs
Onset of pain (spasmodic) is just prior to menstruation.
Dysmenorrhea is secondary when there is an identifiable anatomic or macroscopic pelvic pathological condition. There may be associated vaginal discharge, dysperiunia (painful sexual intercourse), menorrhagia (heavy bleeding at menstruation).
Age at onset : 30- 45 yrs
Onset of pain : Pain (congestive) increases through the luteal phase (before period starts) peaking at onset of menstruation.
Secondary dysmenorrhea may arise from a number of underlying pathological conditions.
– Congenital uterine abnormalities
– Cervical stenosis
– Asherman syndrom
– Chronic ectopic pregnancy
– Pelvic congestion syndrome
– Ovarian cysts or neoplasms
RISK FACTORS FOR DYSMENORRHEA
Young age, early menarche, heavy menstrual flow, nulliparity (state in which a woman has never carried a pregnancy), smoking, depression, anxiety, stress.
Treatment of dysmenorrhea is aimed at providing symptomatic relief as well as inhibiting the underlying processes that causes symptoms.
Primary dysmenorrhea respond to
Treatment of Secondary dysmenorrhea must address the underlying disease ( cyst removal/ removal of submucosal fibroids/polyps etc ). Secondary dysmenorrhea may be resistant to NSAIDs and COCs.
PCOS is the most common endocrine (hormones) syndrome affecting women of reproductive age. It is more prevalent in obese women (28%) than those who are lean.
The effects of PCOS manifest via deranged hormonal profiles, excess of circulating androgen (free testosterone) , increase LH, decrease FSH, Insulin resistance, decrease SHBG (sex hormone binding globulin is a glycoprotien that binds to the two sex hormones:androgen and estrogen).Obesity induced insulin resistance causes an exacerbation of all the symptoms of PCOS.
Lifestyle modification, including a minimum of 30 min of moderately intense exercise at least 3 days per week and dietary interventions is the first line treatment. A weight loss of 5–10% has been shown to decrease testosterone concentrations, increase SHBG, normalize menses and improve fertility in women with PCOS. Prevention of excess weight gain should be emphasized in all women with PCOS with both normal & increased body weight.
Management – continous use of OCPs, progestin, GnRH agonists are used only for girls beyond 16 yrs, LNG- IUS can be used in sexually active adolescents.
PMDD – Premenstrual dysphoric disorder, a severe subtype of PMS.
Symptoms of PMS and PMDD :
|Symptoms associated with PMS and PMDD|
|Physical||Psychological and behavioral|
|Abdominal bloating, weight gain||Anger, irritability|
|Breast tenderness or fullness||anxiety|
|Cramps, abdominal pain (overeating/ food craving)||Changes in appetite|
|fatigue||Decrease in concentration|
|headache||Depressed mood, mood swings|
|nausea||Changes in libido|
|Swelling of extremities||Increased or decreased sleep|
Grading of severity
Management – dietary calcium and vitamin supplements, antidepressants, oral contraceptives, GnRH.