Abstract
Jeanne is 16 and has been coming to you for care since she was a toddler. Her younger siblings see you also. Todays appointment she made herself because she is having trouble with her periods. Since menarche at age 12 she has had monthly periods but two months ago she had a one-day period and missed her period this past month. She had sex once at a party after having a few drinks. She is afraid she might be pregnant and remembers that you told her when she was about 12 that you would respect her confidentiality about sensitive issues. Irregular periods are common in adolescence; many teens do not ovulate monthly for a year or two after their menarche. However pregnancy is the most likely cause of periods in a teen. It is wise to suspect or at least rule out pregnancy when a teen has some irregular periods especially if: use of drugs/alcohol is suspected; there is some instability in the teens family life such as parents divorce or separation remarriage death or parent has a new partner; poor intrafamily communication; family abuse of drugs/alcohol; family history of mental illness especially in a parent; domestic violence. (excerpt)
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