Understanding adolescent menstrual dysfunction

Menstrual issues in teenagers can be distressing and confusing for the young person and their family.

In this article, Dr Cara Williams, a consultant gynaecologist specialising in paediatric and adolescent gynaecology explains what adolescent menstrual dysfunction is, why it happens, and what can be done to manage it.

What is adolescent menstrual dysfunction?

Adolescent menstrual dysfunction refers to irregularities or abnormalities in the menstrual cycle during the teenage years, typically from menarche (the first period) to around the age of 19.

While some degree of variation in periods is normal in the early years, persistent or severe menstrual problems may require medical attention and intervention.

Common types of menstrual issues in teenagers

Many adolescents experience various menstrual problems as their bodies change during puberty. Some of the most common issues seen during this time are:

1. Irregular periods

It’s common for periods to be irregular during the first 2 to 3 years after menarche, as the hormonal system is still developing. However, if periods remain highly irregular or absent for several months, it may signal a deeper issue.

2. Heavy periods (menorrhagia)

Excessively heavy bleeding is one of the most frequent concerns. It’s important to seek advice if a teenager is changing pads or tampons every hour. Heavy periods can lead to fatigue, iron deficiency, and anaemia.

3. Painful periods (dysmenorrhoea)

Mild cramping during periods is normal, but severe pain that interferes with daily activities (school or sports) may be a sign of conditions like endometriosis or a uterine/vaginal malformation.

4. Absence of periods (primary amenorrhoea)

If a teenager has not had their first period by the age of 15, or within three years of breast development, this is considered delayed menstruation and warrants further investigation.

What causes menstrual dysfunction in adolescents?

There are a number of reasons why menstrual dysfunction may occur in teenagers:

Hormonal imbalance

In the early years of menstruation, hormonal fluctuations are common and can lead to irregular cycles. As the body matures, periods typically become more regular.

Polycystic ovary syndrome (PCOS)

PCOS is a common cause of menstrual irregularities. It’s characterised by hormonal imbalances, which can lead to irregular periods, acne, weight gain, and excess body hair.

Thyroid disorders

Both an underactive (hypothyroidism) and overactive thyroid (hyperthyroidism) can interfere with the menstrual cycle, causing periods to become irregular, or in some cases, absent.

Stress and lifestyle factors

High levels of stress, extreme physical activity, eating disorders, and significant weight changes can all disrupt the hormonal balance, leading to menstrual dysfunction.

Bleeding disorders

Heavy periods may have an underlying clotting disorder, like von Willebrand disease, which can affect blood’s ability to clot properly.

Structural issues

In rare cases, physical abnormalities in the reproductive system, such as uterine or vaginal malformations, can cause menstrual irregularities or pain.

How is adolescent menstrual dysfunction treated?

When a teenager presents with menstrual issues, a thorough evaluation is essential. This may include a detailed medical history, blood tests to check hormone levels, and sometimes imaging like an ultrasound or MRI to assess the reproductive organs. A genital examination is rarely required and will not be done if a teenage girl has never been sexually active.

Common treatment options include:

Lifestyle modifications: a healthy diet, exercise, and stress management can help regulate periods.
Medication: non-hormonal treatments can be taken during the period to reduce the flow and pain. Hormonal treatments such as the oral contraceptive pill may be used to regulate periods or reduce bleeding and pain.
Specialist care: in more complex cases (PCOS, endometriosis or vaginal/uterine malformations), a referral to a specialist gynaecologist may be necessary for long-term management.

When to see a doctor

You should consult a healthcare professional if:

Periods have not started by age 15.
There is no regularity 2 years after the first period.
Bleeding is excessively heavy or lasts for more than 7 days.
Period pain is severe and disrupts daily activities.
There are signs of hormonal imbalance (excessive acne or body hair).

Early diagnosis and management can prevent complications and improve quality of life.

While some irregularity in the first few years of menstruation is normal, persistent or severe symptoms should not be ignored.

If your teenager is experiencing persistent or severe menstrual symptoms, consult with Dr Williams via her Top Doctors profile to improve their health and well-being.