The American College of Obstetricians and Gynecologists wants physicians who treat adolescent girls to consider a new vital sign: menstruation.
Once girls begin menstruating, physicians should ask about the first day of the last menstrual period and the pattern of menses at every preventive care or comprehensive visit, according to an opinion from ACOG’s Committee on Adolescent Health Care, released on Nov. 23. This information can help identify early health concerns such as polycystic ovary syndrome, thyroid disease, eating disorders, coagulopathies, or even hepatic failure or malignancy.
“By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers,” the ACOG committee members wrote. “Just as abnormal blood pressure, heart rate, or respiratory rate may be key to diagnosing potentially serious health conditions, identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood.”
The American Academy of Pediatrics endorsed the committee opinion.
Physicians also need to educate girls and their parents about normal and abnormal menstruation, ACOG urged.
Although there are variations, the median age at menarche has been stable for the last 30 years, starting between ages 12 and 13. Studies have shown that higher gain in body mass index during childhood is associated with an earlier onset of puberty (Obstet Gynecol. 2015;126:e143-6).
Most girls will bleed for 2-7 days during their first menses and though it’s normal for menstrual cycles to be irregular in adolescence, 90% of cycles will range from 21 to 45 days, according to the committee opinion. By the third year after the start of menstruation, 60%-80% of cycles are 21-34 days long.
Abnormalities that might signal health problems include menstruation that hasn’t started within 3 years of breast budding, menstruation that hasn’t started by age 14 with signs of hirsutism, menstruation that hasn’t started by age 14 with a history or exam suggestive of excessive exercise or an eating disorder, and menses that are heavy and linked to a history of excessive bruising or bleeding.
“It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient,” the committee wrote.