Paeds · adolescent-and-young-adult-medicine
Menstrual disorders in adolescents
Also known as Abnormal uterine bleeding in adolescents · Adolescent menstrual problems · Heavy menstrual bleeding in adolescents · Dysmenorrhoea in adolescents · Amenorrhoea in adolescents · Adolescent gynaecology
A fellowship approach to menstrual disorders in adolescents: what is normal after menarche, how to classify abnormal uterine bleeding (PALM-COEIN), the work-up for heavy bleeding, dysmenorrhoea and amenorrhoea, stepwise management with combined hormonal contraception, the levonorgestrel intrauterine system, tranexamic acid and iron, and red flags across ANZ, UK, US and Canada.
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Target exams
Red flags
- Heavy menstrual bleeding with haemodynamic instability or symptomatic anaemia
- Severe dysmenorrhoea refractory to NSAIDs and hormonal therapy — suspect endometriosis or outflow obstruction
- Amenorrhoea with low body weight, bradycardia or electrolyte disturbance — functional hypothalamic or eating disorder
- Postcoital, intermenstrual or persistent irregular bleeding — exclude pregnancy, infection, and (rarely) malignancy
- Menorrhagia from menarche with bruising or epistaxis — von Willebrand disease or other bleeding disorder
- Disclosure of sexual coercion, assault or pregnancy with capacity or safeguarding concerns
Life stages
Care settings
Clinical exam formats
Board mappings
- Adolescent medicine and gynaecology
- Menstrual disorders and adolescent reproductive health
- Current 2026 PREP curriculum — Learning goal 6: Clinical management – essential general paediatrics
- Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 13: Healthy populations and preventive health
- Adolescent medicine
- General Paediatrics — reproductive and gynaecological presentations
- Clinical Applications
- Long Cases
- Short Cases
- Communication stations
- 4. Professional skills and knowledge: Patient management
- 5. Health promotion and illness prevention
- 8. Child and young person presenting with gynaecological or reproductive symptoms
- 11. Adolescent health
- General Paediatrics: Investigates and manages menstrual disorders in adolescents including heavy menstrual bleeding, dysmenorrhoea and amenorrhoea
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Communication
- Clinical
- General Pediatrics Content Outline — Domain 11: Adolescent Medicine and Gynecology
- General Pediatrics Content Outline — Domain 4: Endocrine Disorders
- General Pediatrics EPA 3: Providing well-child and adolescent care including reproductive health
- General Pediatrics EPA 6: Providing gender-affirming and adolescent-confidential care
- Patient Care 1: History and Physical Examination
- Patient Care 5: Patient Management
- Medical Knowledge 1: Core gynaecologic and endocrine conditions of adolescence
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Professionalism 1: Confidentiality and adolescent consent
- Medical Expert
- Communicator
- Health Advocate
- Pediatrics: Core EPA — Managing adolescent reproductive health concerns
- Pediatrics: Foundations EPA — Providing confidential care to adolescents
Overview & Definition
A 14-year-old presents with “heavy periods” since menarche a year ago. Her mother says everyone in the family has them. The registrar notes she looks pale and prescribes iron. Eighteen months later she is admitted overnight with a haemoglobin in the 60s and a von Willebrand panel no one ever sent. The miss was not a rare syndrome. It was treating bleeding as an annoyance rather than as a vital sign. [1] [5]
Menstrual disorders in adolescents are any departure from the normal cycle range, volume, timing or associated symptoms that warrants assessment or treatment. The umbrella covers three symptom clusters that overlap in real life: abnormal uterine bleeding (too heavy, too long, too frequent, too infrequent, or absent), dysmenorrhoea (painful menses, primary or secondary), and amenorrhoea (primary or secondary). ACOG framed the cycle as a vital sign precisely so that clinicians would not wave away irregular, heavy or absent menses as “just being a teenager.” [1] [9]
The exam skill is to recognise what is normal for the developmental stage, name the abnormal pattern in objective FIGO terms, and pursue the mechanism rather than the label. An adolescent whose cycles are 40 to 90 days apart two years after menarche is not “stressed.” She has ovulatory dysfunction that needs a cause. [1] [4]
References12ShowHide
- [1]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstetrics and gynecology, 2015.PMID 26595586
- [2]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstetrics and gynecology, 2018.PMID 30461694
- [3]Munro MG, Critchley HO, Fraser IS The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertility and sterility, 2011.PMID 21496802
- [4]Munro MG, Critchley HOD, Fraser IS The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. International journal of gynaecology and obstetrics, 2018.PMID 30198563
- [5]Borzutzky C, Jaffray J Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA pediatrics, 2020.PMID 31886837
- [6]American College of Obstetricians and Gynecologists Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG Committee Opinion, Number 785. Obstetrics and gynecology, 2019.PMID 31441825
- [7]Iacovides S, Avidon I, Baker FC What we know about primary dysmenorrhea today: a critical review. Human reproduction update, 2015.PMID 26346058
- [8]Burnett M, Lemyre M No. 345-Primary Dysmenorrhea Consensus Guideline. Journal of obstetrics and gynaecology Canada, 2017.PMID 28625286
- [9]Kabra R, Fisher M Abnormal uterine bleeding in adolescents. Current problems in pediatric and adolescent health care, 2022.PMID 35525787
- [10]Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ Polycystic ovary syndrome. The lancet. Diabetes and endocrinology, 2022.PMID 35934017
- [11]Mansfield MJ, Emans SJ Adolescent menstrual irregularity. The Journal of reproductive medicine, 1984.PMID 6379175
- [12]Pouraliroudbaneh S, Marino J, Riggs E, Saber A, Jayasinghe Y, Peate M Heavy menstrual bleeding and dysmenorrhea in adolescents: A systematic review of self-management strategies, quality of life, and unmet needs. International journal of gynaecology and obstetrics, 2024.PMID 38654586