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Learn About Menstrual Problems in Adolescents

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Just yesterday your little girl was taking her first steps. Today, she’s asking to shave her legs and wear a bra – and she’s only 9! What’s happening here? Don’t be alarmed if your daughter begins puberty earlier than you did. On average, girls today develop breast buds around age 9. “Soon after, they form pubic hair and go through growth spurts. The first menstrual period arrives anywhere from age 11 on,” says gynecologist Andrea Waxman, MD, with Lehigh Valley Health Network. “Meanwhile, hormones cause girls’ emotions to run high, and boys become more interesting.”

Many menstrual conditions affect adolescent females and require the clinical care of a physician or other health care professional.  Some include amenorrhea, dysmenorrhea, premenstrual syndrome (PMS) and polycystic ovary syndrome (PCOS).

Amenorrhea

Amenorrhea is a menstrual condition characterized by absent menstrual periods for more than three monthly menstrual cycles. Amenorrhea may be classified as primary or secondary.

  • Primary amenorrhea – menstrual periods have not started by age 15.
  • Secondary amenorrhea – menstual periods which had been present are now absent (for at least three months). 

Dysmenorrhea

Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary.

  • Primary dysmenorrhea – painful menstrual cramping and other symptoms, including back pain, thigh pain, nausea, vomiting and diarrhea, that accompany menses
  • Secondary dysmenorrhea – painful menstrual periods caused by medical condition (e.g. endometriosis) 

The cause of dysmenorrhea depends on whether the condition is primary or secondary. In general, females with primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid - both chemicals which control the contractions of the uterus). Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis (a condition in which endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs in the pelvis or in the abdominal cavity – often resulting in pelvic or abdonminal pain that may vary with the menstrual cycle). Other possible causes of secondary dysmenorrhea include the following:

Premenstrual syndrome (PMS)

Many teens experience some unpleasant or uncomfortable symptoms during their menstrual cycle. For some, the symptoms are significant, but of short duration and not disabling. Others, however, may have one or more of a broad range of symptoms that temporarily disturb normal functioning. These symptoms may last from a few hours to many days. The types and intensity of symptoms vary between individuals. This group of symptoms is referred to as premenstrual syndrome, or PMS. Although the symptoms usually cease with onset of the menstrual period, in some women symptoms may last through and after their menstrual periods.

According to the American College of Obstetricians and Gynecologists, nearly 85 percent of women during their reproductive years experience at least one of the common symptoms associated with PMS. It is estimated that 5 percent of women have symptoms so extreme that they are considered disabled by the condition.

The cause of premenstrual syndrome is unclear, but seems to be related to fluctuations in estrogen and progesterone levels in the body, and does not necessary mean there's abnormal ovarian functioning. Social, cultural, biological and psychological factors have been identified as possible contributors to PMS.

Making simple lifestyle changes helps to reduce the occurrence of PMS symptoms. These changes may include:

  • Regular exercise (three to five times each week)
  • A well-balanced diet – It is generally recommended that those with PMS increase their intake of whole grains, vegetables and fruit, while decreasing their intake of salt, sugar, caffeine and alcohol.
  • Adequate sleep and rest
  • Not smoking

Learn more about premenstrual syndrome symptoms, diagnosis and treatment.

Polycyctic ovary syndrome (PCOS)

Polycystic ovary syndrome (also called PCOS or Stein Leventhal syndrome and more recently referred to as functional ovarian hyperandrogenism) is the most common hormonal and reproductive problem affecting women of childbearing age. It is estimated that about 5 percent adolescents and young women have this disorder.

Key features of PCOS include:

  • Hyperandrogenism - meaning elevated levels of androgens (male-type hormones) in the blood
  • Clinical evidence of elevated androgenic activity such as hair growth in the areas more typically seen in males (face, chest, abdomen), acne or male-pattern hair loss
  • Many small cysts (fluid-filled sacs) on the ovaries may be present, but are not required to make the diagnosis

The exact cause of PCOS is unclear. It's common for sisters or a mother and daughter to have PCOS, but a definite inheritance pattern hasn't been found. 

PCOS results from a combination of several related factors. Many women with PCOS have insulin resistance, in which the body can't use insulin efficiently. This leads to high circulating blood levels of insulin, called hyperinsulinemia. It's believed that hyperinsulinemia is related to increased androgen levels, as well as obesity and type 2 diabetes. In turn, obesity can increase insulin levels, causing worsening of PCOS.

Ovulation is a process in which a mature egg cell (also called an ovum) is released from one of the ovaries (two female reproductive organs located in the pelvis). If the egg doesn't become fertilized as it travels down the fallopian tube on its way to the uterus, the endometrium (lining of the uterus) is shed and passes through the vagina (the passageway through which fluid passes out of the body during menstrual periods; also called the birth canal), in a process called menstruation.

In PCOS, the woman's reproductive system doesn't produce the proper amounts of hormones necessary to develop, mature and release a healthy egg. In addition, abnormally high levels of androgens are produced by the ovaries. 

Learn more about polycystic ovary syndrome symptoms, diagnosis and treatment.

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