Gynecological Problems in Adolescence

Amenorrhea (No menstrual bleeding):

Primary Amenorrhea: The absence of menstrual bleeding up to 14 years old in those who have not started pubertal development or the absence of menstrual bleeding up to 16 years old in those who have started pubertal development.

Secondary Amenorrhea: It is the cessation of menstruation after 18 months after the menarche (first menstrual period), or no menstruation after 6 months after regular menstruation, or in the case of Oligomenorrhea, no menstruation during the 3 consecutive periods.

Causes of Amenorrhea

Amenorrhea with delayed Puberty

This is the beginning age of puberty is below the average values.
13.5 years old breast development has not started,
No pubic hair growth at the age of 14,
No menstruation at the age of 16,
More than 5 years have passed (breast development) and menarche (first menstrual bleeding),

Amenorrhea with normal puberty.

Hormonal causes (Hyperandrogenism is the immature of the Hypothalamic-pituitary-ovarian axis).
Pregnancy and lactation are other causes of physiological amenorrhea.

Amenorrhea with genital tract anomalies.

Treatment Purposes in Amenorrhea; Restoring the ovulatory cycle. Hormone replacement therapy (estrogen-progesterone therapy). To prevent anxiety. Frequent evaluation.

Dysmenorrhea; (Menstrual Pain)

It is pain in menstrual period. Prostaglandins play a role in its pathogenesis

There is no specific pathology in primary dysmenorrhea.

Secondary Dysmenorrhea; In pathological conditions of the pelvic organ (endometriosis, salpingitis or congenital anomalies of the mullerian system, etc.)

In the Treatment of Dysmenorrhea: Non-Steroid Anti-inflammatory, Oral Contraceptives, Ca Channel Blockers, Acupunture, Transcutaneous Electric Nerve Stimulation

Menstrual Irregularities: In the normal menstrual cycle; December: 21 - 45 days, Duration: 3 - 7 days

Blood loss: 30-40 ml (<80 ml). (Cycle changes are more common in adolescents than adults)

Dysfunctional Uterus Hemorrhages (DUK)

Dysfunctional uterine bleeding (DUK) is defined by abnormal endometrial bleeding without structural pathology.

Menorrhagia: excessive bleeding during the menstrual period,
Metroragy: frequent and irregular bleeding,
Menometragy: menorrhagia + metroragy. Frequent and excessive bleeding.
It is necessary to differentiate dysfunctional uterine bleeding from other bleeding causes. These; Hypothalamus, pituitary and ovarian axis immature, Pregnancy, Uterus and vagina abnormalities, Endocrine abnormalities (hypothyroidism, hyperthyroidism, hyperprolactinoma, cushing, addison), Systemic diseases (liver hast., Kidney hast., Leukemia, iron deficiency anemia, anticonvulsants, intrauterine , endometriosis), Coagulapathies.

TREATMENT; Hemoglobin value; Iron treatment and oral contraceptive treatments if less than 12 gr/dl,
If there is active bleeding less than 10 gr / dl; iron + oral contraceptive treatments and hospitalization are recommended. If bleeding does not improve with medical treatment, bleeding is stopped with curettage.

Polycystic Ovary Syndrome

The most common complaint is menstrual irregularities since adolescence. This irregularity is usually in the form of menstrual delays. From time to time, there may be amenorrhea, ie no menstruation. The bleeding seen after the delay is usually excessive and prolonged.

In the following period, male pattern hair growth (hirsutism) is observed that increases gradually over the years. "Hairiness" in the case of hair growth in areas such as the upper lip on the upper lip, chin bone and cheeks, the area around the navel, the area around the navel, the groin and the navel, the inner faces of the legs, the back and the hip, which are considered to be "male pattern hair areas" in women. or medical hirsutism. Hair growth is the first sign of transition to puberty in the pubis (genital) region, and girls who start hair growth early (before 8 years of age) are likely to develop polycystic ovarian syndrome in the future. Polypystic ovary syndrome is the main problem in 15-40% of women who applied to the doctor because of the problem of hair growth. appears to have a hairy complaint.

Vaginal Discharge

Physiological discharge; It appears just before the mentor (first menstrual bleeding) or during the menarche. The discharge is typically clear or whitish, its consistency may vary due to hormonal effects. Odorless. One year before menarche, lactobacilli dominate the vaginal flora and the pH returns to acid.

Fungal Infection (Monilia, Candida); It usually develops after antibiotic treatment. Itching in the vulva. Before menstruation, discharge is observed in the consistency of cheese. Taking vaginal cultures is often unnecessary.

Bacterial Infections; Gardnerella, Haemophilus, Peptococcus, Lactobacili are observed in those who are not sexually active. In those who are sexually active, Trichomonas foul smelling, mild discharge is observed.

Op. Sibel Malkoç, MD

Gynecology and Obstetrics Specialist

Dr. Sibel Malkoç attended many domestic and international training seminars and congresses during 25 years of specialised physician service.

Pregnancy follow-up, urinary incontinence surgery and laser treatments, genital aesthetic surgery and laser applications and vaginismus treatment are of special interest.

It serves its patients especially in surgical and laser-assisted Vagina aesthetics.

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