Menstrual Disorders in Adolescents: Few Observations

Abstract

Sir, Menstruation is the hallmark of female pubertal development. It has an important bearing on fertility, bone and cardiovascular status of the girls’ future life. Hence, adolescents and their parents should be made aware about the variability of a normal menstrual cycle and menstrual disorders per se. In this regard the study done by Nair et al. [1] is really appreciable. However there are certain observations which are intriguing. This study defines oligomenorrhoea as infrequent, irregularly timed episodes of bleeding occurring at intervals of >35 d. However, available literature generally defines it as infrequent, irregular bleeding of ≥45 d [2]. The length of normal menstrual cycle in adolescence can vary from 21 to 45 d [2]. Further Diaz et al. [3] stated that cycle length of 21–35 d is established only around the 6th gynecologic year, at a chronological age of 19–20 y. By the 4th gynecologic year, the 95th percentile for cycle length is around 50 d [3]. In the present study 97.5 % girls are in the age group 15–17 y with majority in the 4th or 5th gynecologic year [1]. Thus the percentage of girls with oligomenorrhea may be overestimated thereby increasing the risk for the future development of Polycystic ovarian disease. This may result in unwarranted negative counseling on the part of the consulting pediatrician. In an earlier study, Van Hooff et al. (2004) found a subset of girls whose cycle length (35–41 d) was within normal limits but the cycles were highly irregular [4]. This subgroup was separately specified as Mild Oligomenorrhea. These were also found to be at a high risk for remaining oligomenorrheic at the age of 18 y and hence may have long term consequences [4]. It would be interesting to know if the present study also identified any subset of mild oligomennorhea. Further, the present study does not clearly state the criteria used for defining irregular menstrual cycle. Considering the high variability of menstrual cycle patterns in adolescence, standard guidelines are required for defining the various terminologies regarding cycle length, regularity etc. This will enable the pediatricians to diagnose the conditions accurately and counsel the adolescents and their parents appropriately.