By: Kerry Gannon-Loew, MD, MS, FAAP
For many teens, getting their first period is a big milestone. Menstruation usually starts between ages 10 and 15 years old. It's normal for menstrual cycles to be irregular during the first few years. But sometimes, period problems go beyond the usual ups and downs.
Painful cramps, missed or irregular periods or heavy bleeding can be signs of a menstrual disorder. These issues, while common and treatable, can affect your teen's health, confidence and daily life. It helps to know what's typical, and when to reach out to their doctor.
Below are some of the most common menstrual disorders in teens. Learn what causes them, how they're diagnosed and treatment options.
Amenorrhea (no periods)
Amenorrhea is the absence of menstrual periods.
Types of amenorrhea
Primary amenorrhea is when a teen does not get their period by age 15.
Secondary amenorrhea is when a teen who was getting regular menstrual periods does not get their period for 3 months in a row or more.
What is a regular menstrual cycle & when does it typically start?
A regular menstrual cycle means having a period about once a month. It is common for teens to have irregular periods in the first 2 to 3 years after their first period.What causes amenorrhea?
Primary amenorrhea can happen for several reasons, such as:
Genetic conditions that affect development
Hormone imbalances in the brain
Problems with how the uterus, vagina or hymen formed before birth
Both primary and secondary amenorrhea can be related tod:
How is amenorrhea diagnosed?
If your teen hasn't had their first period (menarche) by age 15, or stops having periods for more than 3 months, they should see their doctor for medical evaluation.
A medical provider will:
Take a thorough medical history, review weight and vital signs
Perform a focused physical exam based on the history and symptoms
Order blood work or imaging tests to help determine the cause of amenorrhea including:
Pregnancy test
Thyroid function tests
Hormone levels (FSH, LH, estradiol, prolactin, testosterone)
Pelvic ultrasound
Blood work to check for other medical conditions, including complete blood count (CBC), inflammatory markers and kidney function tests
How is amenorrhea treated?
Treatment will depend on the underlying cause of amenorrhea. Your child's doctor will recommend the best plan.
Abnormal uterine bleeding (AUB)
Abnormal uterine bleeding (AUB) involves unpredictable timing of periods and variable amount of blood flow. This can include:
What causes AUB?
One common cause is anovulation, when the ovaries don't release an egg. This is common during the first few years after a teen starts their period. Cycles of hormones are still maturing, and this can lead to irregular or less frequent periods.
It is rare for teens to go more than 3 months between periods, even in the first 2 years. If this happens, a teen should see a medical provider to discuss their periods.
How is AUB diagnosed?
A medical provider will:
Take a thorough medical history
Do a focused physical exam. A pelvic exam is usually not needed or recommended to diagnosis AUB.
Order tests, if needed to help rule out other causes and make sure bleeding is not too heavy. These may include:
Pregnancy test
Testing for sexually transmitted infections (STIs)
Blood count to check for anemia
Thyroid function tests
Measure of hormone levels may be helpful depending on the history
How is AUB treated?
Depending on the underlying cause, oral contraceptives (birth control pills) can help regulate period cycles and manage heavy bleeding.
If irregular periods are likely related to anovulation, the teen's medical provider may also provide reassurance and recommend close monitoring of cycles.
Dysmenorrhea (painful periods)
Within a year or two of their first period, 50-75% of teens begin to experience painful menstrual cramps, called dysmenorrhea.
For most teens, cramps happen because of chemicals called prostaglandins, which are released by the uterus and cause pain. Treatments can help manage symptoms.
Some cases of dysmenorrhea may be related to a gynecologic disorder called endometriosis. With endometriosis, tissue that normally lines the inside of the uterus grows outside of it, in other areas of the pelvic cavity (lowest part of the abdomen). This causes pain.
Symptoms of dysmenorrhea
Symptoms typically begin 1 to 2 days before the start of bleeding and include:
How dysmenorrhea is diagnosed
A health care provider will:
Take a thorough medical and family health history, as well as menstrual history.
Do a focused physical exam. Usually, a pelvic exam is not needed. Blood work and imaging typically are not needed to diagnosis dysmenorrhea, either.
If a provider suspects endometriosis (for instance, if there is a strong family history and cramps do not respond to treatment), they may recommend further evaluation or referral to a specialist.
How is dysmenorrhea treated
NSAIDs (nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen). These medications block the uterus from releasing prostaglandins (the chemicals causing the pain).
Acetaminophen may be helpful if a teen cannot take ibuprofen.
Certain contraceptives can also be used to relieve cramps. These methods include combined hormonal contraceptives, oral progestins and the progestin injection (Depo Provera), as well as the contraceptive implant (Nexplanon) and levonorgestrel intrauterine device (IUD).
Heavy menstrual bleeding
When is menstrual bleeding considered heavy?
Bleeding lasts more than 7 days
Bleeding soaks through 1 or more pads or tampons in 1-2 hours, for multiple hours
Needing to wear double protection (more than one pad or a pad and a tampon at one time) to control bleeding
Needing to change pads or tampons during the night
Passing blood clots that are quarter-size or larger
What causes heavy menstrual bleeding?
Heavy periods in teens often happen because they aren't ovulating regularly. When ovulation doesn't occur, the lining of the uterus can build up and lead to heavier bleeding during a period. Other possible causes:
How is heavy menstrual bleeding evaluated?
If a teen is experiencing heavy periods, it is recommended they see a medical provider to discuss the symptoms.
The provider will:
Take a thorough history, including family history
May recommend labs to evaluate for anemia (blood counts and iron level) and hormones to check for other causes
How is heavy menstrual bleeding treated?
Oral contraceptives often make periods lighter and shorter. Levonorgestrel IUDs can significantly lessen bleeding or cause periods to stop.
Tranexamic acid: prescription medication to treat heavy menstrual bleeding
When should your teen see a health care provider about period concerns?
Not having a period by age 15, going greater than 3 months between periods or periods still irregular after 2 years.
Heavy periods that require changing a menstrual product every 1-2 hours or lasting longer than 7 days.
A change in periods. If periods were previously happening every month and are now irregular.
Significant cramps or other symptoms at the time of periods that are limiting daily activities or leading to missed school.
RememberIf your teen’s periods seem unusual, cause significant discomfort or interfere with their everyday activities, reach out to their doctor. Early evaluation and care can help your teen feel better and stay healthy.
More informationAbout Dr. Gannon-Loew
Kerry Gannon-Loew, MD, MS, FAAP, is a board-certified pediatrician and adolescent medicine physician and an Assistant Professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health. She is a member of the American Academy of Pediatrics Section on Adolescent Health and has a special interest in working with adolescents with eating disorders, menstrual concerns and substance use disorders.
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