2025 – PAGE 70 – ADOLESCENT MEDICINE
ABNORMAL UTERINE BLEEDING (AUB)
During the first two years of menstruation, infrequent menstrual cycles, or cycles lasting 2–3 days is OKAY. Menstrual periods lasting > 7 days are abnormal and require a workup including pregnancy testing (hCG), CBC, coagulation factors, CMP, TSH, androgens, FSH, LH, and prolactin levels.
PEARL: AUB can be about volume (flow measuring > 80 mL per cycle is abnormal), duration (cycles lasting > 8 days are abnormal), or frequency (a cycle frequency outside of the 24-38 day range is abnormal). Lastly, AUB has replaced terminology that was previously not clearly defined (menorrhagia, menometrorrhagia, and dysfunctional uterine bleeding).
PREMENSTRUAL SYNDROME & DYSMENORRHEA
PREMENSTRUAL SYNDROME (PMS)
Premenstrual Syndrome (PMS) is defined as cyclic affective/mood components + somatic components usually occurring within the 5 days prior to menstruation. The first line treatment is NSAIDS, and the second line is fluoxetine.
PEARL: Options for first line treatment of PMS or Dysmenorrhea may not include Ibuprofen or NSAIDS in the answer choices. The correct answer could be disguised as a CYCLOOXYGENASE SYNTHETASE (COX) INHIBITOR!
PRIMARY DYSMENORRHEA
Primary dysmenorrhea is defined as painful menses and has no affective/mood component. It is due to PGE, so give NSAIDS. The usual description is CRAMPY pain. The diagnosis is likely PRIMARY DYSMENORRHEA even if the vignette says that the patient didn’t respond to NSAIDS. She probably took the NSAIDS too late! NSAIDS should be started at the onset of menses or, in the case of severe dysmenorrhea, 2–3 days before the expected onset. Symptoms can occur before or during menses, and usually do not start until a girl’s cycles become ovulatory (6–12 months after menarche).
SECONDARY DYSMENORRHEA
Secondary dysmenorrhea is due to PELVIC PATHOLOGY, such as endometriosis, pregnancy, ectopic pregnancy, etc.
SOCIAL ISSUES
AUTONOMY
Allow kids autonomy within their abilities unless they are a danger to themselves. This means they should be able to make decisions for themselves regarding chronic illness if you deem they are able to understand the implications of their decisions.
BREAST EXAMS
Teaching breast self-examination to any female is no longer recommended.
RAPE/PTSD
Rape and PTSD are associated with nightmares, a desire NOT to be alone, poor appetite, poor grades, abdominal pain, and vaginal discharge (probably from an STD).