May 04 2008
Adolescent Health-education:What can go wrong with menstrual periods? part 2
A decision to use birth control pills should not be made casually. A medical evaluation to rule out other causes of pain may be necessary. Nausea, headaches, bloating, and/or worsening of acne are unpleasant side effects experienced by some users. The pills must be taken consistently each day to be effective.
In addition, the use of birth control pills may raise parental concern: Could taking them for menstrual cramps (or any other therapeutic purpose) indirectly lower your adolescent’s resistance to sexual activity? If you don’t know the answer to this question, now is the time for candid conversation about sexuality. It would be unfortunate to withhold a treatment that might reduce debilitating pain because of a parent’s vague mistrust of an adolescent who is actually fervently committed to remaining abstinent. Furthermore, the decision to postpone sex until marriage should be built on a strong, multilayered foundation. If the absence of contraceptives is the only reason she is avoiding intercourse, she needs to hear and understand many more reasons.
Irregular menstrual periods may be a cause for concern if they are
- too rare, occurring every three or four months after more than a year has passed since the first period;
- too frequent, with bleeding or spotting occurring throughout the month;
- too long, lasting more than seven or eight consecutive days;
- too heavy, soaking through more than six to eight pads/tampons per day.
For any of these problems, a medical evaluation is usually indicated to discover the underlying cause. In many instances the diagnosis will be anovulatory cycles resulting from an immature endocrine system. But other physical or even emotional events can also interfere with the complex interaction of hormones that brings about the monthly cycle. These include:
Medical disorders. These could include malfunctions of the endocrine system (including pituitary, adrenal, or thyroid glands) or abnormalities of the ovaries, uterus, or vagina.
Significant changes in weight. Obese adolescents can generate enough estrogen in their fat cells to impact the lining of the uterus. At the opposite extreme, stringent diets or the severe reduction in food intake seen in anorexia will effectively shut down the menstrual cycle.
Extreme levels of exercise. Female athletes with demanding training programs may have infrequent periods or may stop their cycles altogether.
Stress. Stormy emotional weather is no stranger to the adolescent years, and personal upheavals can cause a teenager to miss one or more periods.
Pregnancy. In some cases an unexpected absence of menstrual cycles indicates that an unplanned pregnancy has begun.
It is important that extremes in menstrual flow (whether too much or too little) be evaluated. Not only may the underlying cause have great significance, but the menstrual irregularity could have damaging consequences of its own. For example:
Very frequent or heavy bleeding may outstrip an adolescent’s ability to replenish red blood cells, leading to iron deficiency, anemia. Often there is an inadequate amount of iron in the diet to keep up with what is being lost each month. Anemia can cause ongoing fatigue, poor concentration in school, light-headedness, or even fainting episodes.
Absence of menstrual periods related to a continual failure to ovulate may result in months or years of nonstop estrogen stimulation of the uterus. Without the maturing effect of progesterone, the lining of the uterus may be at increased risk for precancerous abnormalities.
Adolescents who stop their cycles because of weight loss or intense physical training (or both) may suffer an irreversible loss of bone density, known as osteoporosis. Normally a problem faced by women much later in life (typically well after menopause), osteoporosis can lead to disabling fractures of the spine, hips, wrists, and other bones.
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