QUESTION: My daughter won't discuss this with me openly, but I know she is worried and anxious.
I need some information before I open the conversation with her.
What does it mean when a teenager gets abnormal periods?
ANSWER: Irregular vaginal bleeding is fairly common in adolescents because even though menstruation begins, it initially is not accompanied by ovulation in almost 50% of all teenage girls.
Initially the bleeding occurs after estrogen (a female hormone) causes a buildup or thickening in the endometrium (the tissue which lines the uterus), which sheds and bleeds irregularly after a few months because the endometrium cannot support the thick layer.
A temporary reduction in estrogen levels can also cause the bleeding, as can a lack of progesterone, the hormone responsible for ovulation.
Since a true hormonal balance and the onset of ovulation frequently don't develop until mid- or late puberty, menstrual irregularity can be quite common. However, in managing teenagers exhibiting such irregularities, it is important to distinguish a normal variation from an actual abnormality. Bleeding is usually labeled clinically abnormal when painless heavy bleeding persists for over a week and occurs more frequently than at 21-day intervals. These symptoms, as well as the development of secondary anemia due to large losses of blood, should be investigated. To diagnose an abnormality, tests are performed to rule out other serious causes such as congenital uterine abnormalities, cervical polyps, pelvic inflammatory disease, or coagulation defects.
Once these and other possible complications are eliminated, evaluation and treatment can be initiated.
In nonemergency cases, when the girl is not actively bleeding and has a hemoglobin count of ten or more grams, management is fairly simple.
The patient is instructed to keep a menstrual calendar and is placed on a high protein diet with adequate rest and recreation.
In some cases, oral iron supplements are given.
Ultimately, the hope is that ovulation will develop spontaneously and with it, regular and mildly painful periods. In emergency cases, when there is active bleeding and low hemoglobin, treatment is more complicated.
Since progesterone is responsible for ovulation, oral progestins or other synthetic progestogens are administered with small amounts of estrogen.
One tablet taken four times a day after meals should stop the bleeding within two days.
The dose should then be reduced to one or two tablets for a couple of weeks.
Withdrawal bleeding follows. After this initial hormone treatment, the patient is given a low-dose oral contraceptive for three to four months to prevent a recurrence.
Oral contraceptives can be very effective in regulating cycles and after a few months of treatment, patients will usually resume ovulation and regular periods.
However, all patients who exhibit dysfunctional uterine bleeding should receive continuous long-term observation because some may never ovulate and will continue to experience recurrent clinical problems. Quite simply, none of this evaluation or treatment can start until you and your daughter have a heart to heart, "sit-down" conversation.
Sure she's worried, and maybe a bit frightened as well.
Remember your first experiences? Once you're past the anxieties, and a little time has passed, it will all probably straighten out by itself.
If not, a visit to the physician is then in order.
The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.
