themenschwerpunkt

Wien Med Wochenschr (2010) 160/1516: 406413

DOI 10.1007/s10354-010-0805-2
Springer-Verlag 2010
Printed in Austria

Incidences of menstrual cycle abnormalities

in adolescence, and matches between
the age at menarche and the development
of menstrual cycle abnormalities
Mercedes Juliana Art and Daniela Doerer

Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria

Received July 16, 2009, accepted (after revision) March 29, 2010

Hugkeiten von Zyklusstrungen
bei Jugendlichen sowie Zusammenhang
zwischen dem Zeitpunkt der Menarche
und der Entstehung von Zyklusstrungen
Zusammenfassung. In jener Studie wurden die klinischen
Daten aller Mdchen, die von 20012008 auf der kinder-und
jugendgynkologischen Ambulanz der Universittsfrauenklinik
in Wien wegen Zyklusstrungen betreut worden sind, ausgewer-
tet (n 255). Am hugsten litten die Patientinnen unter Dys-
menorrhoe (29 %), Tempoanomalien (24 %) und Metrorrhagie
(19 %). Insgesamt konnte in 57 % eine zugrunde liegende Ursache
festgestellt werden. In der Mehrheit der Flle (24 %) war diese
hormonellen Ursprungs. Die Therapie war in 54 % eine hormo-
nelle. In einem zweiten Schritt widmete man sich der Frage nach
einem mglichen Zusammenhang zwischen dem Zeitpunkt der
Menarche und der Entstehung von Zyklusstrungen. Hierfr
wurden die Mdchen mit primrer Amenorrhoe von der Analyse
ausgeschlossen (n 219). Das Ergebnis war jenes, dass jedes
Menarchenalter zu einer speziellen Art der Zyklusstrung fhrte,
von welcher die Patientin anschlieend am hugsten betroffen
war. Lediglich bei einer Menarche mit 16 Jahren waren zwei
Strungen gleich hug genannt worden.
Schlsselwrter: Zyklusstrungen, Zyklusdauer, Ursachen,
Therapieoptionen, Menarche
Summary. In this study the clinical data of all girls who visited
the ambulance for paediatric and adolescent gynaecology at the
university clinic for gynaecology and obstetrics in Vienna be-
tween 2001 and 2008 because of menstrual cycle abnormalities
were used (n 255). Most frequently, the girls suffered from
dysmenorrhoea (29%), tempoanomaly (24%) and metrorrhagia
(19%). For 57%, it was possible to nd an underlying cause,
Correspondence: Mercedes Juliana Art, M.D., Department of Obstet-
rics and Gynaecology, Medical University of Vienna, Waehringer
Guertel 18-20, 1090 Vienna, Austria.
Fax: 43-1-40400 2911, E-mail: mercedes_art@yahoo.de
mainly (24%) a hormonal one. The therapy was in 54% of all
cases hormonal. In a second step, the study analyses matches
between the age at menarche and the development of menstrual
cycle abnormalities. Girls with primary amenorrhoea were ex-
cluded (n 219). The study shows that every age of menarche has
its special kind of menstrual cycle abnormality. Only if the
menarche had set in at the age of 16, two kinds were named
with equal frequency.
Key words: Menstrual cycle abnormality, cycle length, causes,
therapy, menarche
Introduction
Between the age of seven and ten, in the so-called
pre-puberty phase, girls gain in weight. This is associ-
ated with a marked increase of the leptin-production
via the adipocytes. Via neuropeptide y, leptin can stim-
ulate the central neuro-endocrine impulse generator in
the nucleolus arcuatus, which starts thereupon with the
production and disposal of gonadotropin releasing
hormone (GnRH). Subsequently, it comes to a gradual
augmentation of the amplitude and the frequency of
GnRH-episodes: rstly, GnRH-pulses are delivered
sporadically and spontaneously, then they are associ-
ated with sleep. With increasing puberty the frequency
sample accelerates, leading to a mature rhythm of an
adult female person with a GnRH-pulse at every
90120 min. Via the portal venous system of the infun-
dibulum, GnRH reaches the gonadotropine cells of the
pituitary gland where it operates as the physiological
impulse for the production and disposal of the follicle
stimulating hormone (FSH) as well as the leuteinising
hormone (LH). The function of FSH is only the stimu-
lation of the granulosa cells. LH, on the other hand,

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stimulates the syntheses of androgens of the theca
interna cells via production of testosterone and andro-
stenedione. Via the theca interna cells the androgens
are forwarded to the granulosa cells and there they are
altered into estradiole via the FSH-dependent aroma-
tises. Because of the increasing GnRH-pulse activity of
the hypothalamus the synthesis of FSH can increase
rapidly until a sufcient concentration of estradiole,
which is needed for the development of the endome-
trium, is achieved. The rst deprivation of estradiole
leads to a withdrawal bleeding which is the so-called
menarche [1].
The main gynaecological problems amongst ado-
lescent girls are menstrual cycle abnormalities.
Slap detected that problems associated with men-
struation affect 75% of adolescent females and are a
leading reason for visits to physicians [2].
Drosdozol and Skrzypulec published in 2008 that
the main problem in paediatric and adolescent gynae-
cology is the dysmenorrhoea. Adolescent girls suffer
especially from the primary form. They have normal
menstrual cycles and no pathologies of the pelvis. Only
10% of the girls are affected by the secondary form. The
main underlying causes of the secondary form were
endometrioses, inammatory pelvic diseases, congeni-
tal mullerian malformations as well as ovary cysts [3].
Harel also asserted that dysmenorrhoea is the
most common gynaecologic complaint amongst ado-
lescent females. It is usually primary, only 10% of the
girls suffer from the secondary form with pelvic abnor-
malities such as endometrioses or uterine anomalies.
Potent prostaglandins and leukotrienes play an
important role in generating the symptoms of dysmen-
orrhoea. Non-steroidal anti-inammatory drugs
(NSAIDs) are the most common pharmacological treat-
ments for dysmenorrhoea. Adolescents with symptoms
that do not respond to treatment with NSAIDs for three
menstrual periods should be offered hormonal treat-
ment such as combined oestrogen-progesteron oral
contraceptives for three menstrual cycles. Adolescents
with dysmenorrhoea who do not respond to this treat-
ment should be evaluated for secondary causes of
dysmenorrhoea [4].
Denition of terms used to describe
menstrual cycle abnormalities
The term amenorrhoea stands for the abstinence
of menstruation. Amenorrhoea can be divided into a
primary and a secondary form. The primary form
means a menarche which has not occurred until the
wmw 1516/2010 Springer-Verlag Art and Doerer Incidences of menstrual cycle abnormalities in adolescence
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age of 16. Underlying causes can be anatomical aberra-
tions or pervasive diseases like chromosomal anoma-
lies. In the secondary form, the girls already had a
menstrual bleeding before, but it failed to appear for
at least six months. Causes therefore are diseases like
problems with the thyroid gland, diabetes mellitus,
hormonal anomalies like hyperandrogenemia, polycys-
tic-ovary-syndrome or hyperprolactinemia, as well as a
gain in weight, an ovarian insufciency, stress, a heavily
physical strain as well as a problem in the hypothalam-
ic-pituitary-ovary-axis.
A clear differentiation between the primary and
the secondary form is the fact that a girl with the
secondary form has an uterus and a production of
oestrogen. Of course, it is necessary to exclude the
existence of a gravity before one makes the diagnosis
of a secondary amenorrhoea.
The term hypermenorrhoea means a very strong
menstrual bleeding with a loss of blood of more than
80 ml (normally a women loses circa 3040 ml blood
during her menstruation).
The term menorrhagia means a very strong and
durable menstrual bleeding. Non-hormonal drugs used
are mostly prostaglandin-inhibitors. The hormonal
substance in use is basically progesterone.
Hypomenorrhoea is a very light bleeding. It oc-
curs especially upon taking oral contraceptives.
Dysmenorrhoea is the medical term for a painful
menstruation. This kind of menstrual cycle abnormal-
ity appears especially in adolescent girls [5]. In the
primary dysmenorrhoea, there are no pathologies of
the pelvis. The symptoms start with the menarche or
between six and twelve months afterwards. The pri-
mary dysmenorrhoea is characterised by spastic ab-
dominal pain, which radiates to the back. This pain
starts a few hours before the menstrual bleeding be-
gins and continues for about one to three days. There
are often additional gastrointestinal or vascular pro-
blems like nausea, vomiting, diarrhoea, headache,
fatigue, hufness as well as syncope. Especially girls
and young women, who have not given birth yet, suffer
from this kind of menstrual cycle abnormality. The
grievances often disappear when the woman is preg-
nant for the rst time.
The synthesis of prostaglandin in the uterus is
controlled by progesterone. Cycles without an ovula-
tion are not painful, because the progesterone level
cannot increase without the corpus luteum. Prostaglan-
din F2 alpha and E2 are connected to dysmenorrhoea.
For the therapy, prostaglandin-inhibitors are used.
Pathologies of the pelvis are predominant in the
secondary form of dysmenorrhoea. To be able to make
407
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a correct diagnosis, a laparoscopy is needed. A frequent
cause is an endometriosis [6].
Contrary to the dysmenorrhoea, a premenstrual
syndrome means an existing pain in the luteal phase,
which is the second half of the menstrual cycle, which
disappears at the beginning of the menstrual bleeding.
The term dysfunctional bleeding stands for men-
orrhagia which is a very strong, painful and durable
bleeding as well as metrorrhagia which is the medical
term for bleedings which appear at every time of the
menstrual cycle, so-called spotting.
Oligomenorrhoea means a cycle length of over
35 days. Polymenorrhoea is the medical term for a
menstrual cycle with less than 2022 days. Many of these
abnormalities express a cycle without ovulation [6].
The term tempoanomaly is used in this study to
describe cycles with a cycle length that is monthly
different. The range reaches from a few days to several
months in the same female patient.
rhoea, premenstrual syndrome, menorrhagia as well as
metrorrhagia), amount of coexisting menstrual cycle
abnormalities, causes (hormonal, organic, others) as
well as therapy options (hormonal, non-hormonal,
none). Girls with a menarche between nine and 16 years
were enclosed in the study. All clinical data were sta-
tistically analysed with Excel Version 2000.
This retrospective analysis was intended to de-
scribe the matches between the age at menarche and
the development of menstrual cycle abnormalities in
these female patients.
All of the girls in this study had gynaecological
problems, which ranged from painful, very strong men-
struation bleedings to primary amenorrhoea and were
carefully gynaecologically examined.
If the physician had a suspicion that the girl could
suffer from a hormonal dysfunction, a hormonal anal-
ysis was requested. Hormonal problems like hyperan-
drogenemia have often been the underlying cause of
the development of menstrual cycle abnormalities.

Methods Results
In a rst step, the clinical data of all girls who visited Part 1: Incidences, causes of and therapy options
the ambulance for paediatric and adolescent gynaecol- for menstrual cycle abnormalities
ogy at the university clinic for gynaecology and obstetric The study shows that the dysmenorrhoea, followed by
in Vienna between 2001 and 2008 because of menstrual the tempoanomaly are together responsible for more
cycle abnormalities were used (n 255). Girls between
nine and 16 years were enclosed in the study. The
following parameters were analysed: kind of menstrual Tab. 1: Incidences of menstrual cycle
cycle abnormality (polymenorrhoea, oligomenorrhoea, abnormalities (number of patients
tempoanomaly, hypermenorrhoea, hypomenorrhoea, and percentage); multiple answers
primary amenorrhoea, secondary amenorrhoea, dys- possible; numbers are rounded
menorrhoea, premenstrual syndrome, menorrhagia as Menstrual Incidences
well as metrorrhagia), number of coexistent menstrual cycle anomaly
cycle abnormalities, menstrual cycle length, causes Number Percentage
(hormonal, organic, others) as well as therapy options of patients
(hormonal, non-hormonal, none). The statistic evalua-
Dysmenorrhoea 73 29
tion was done with Excel Version 2000.
In a second step the study investigates whether Tempoanomaly 62 24
there are matches between the age at menarche and the Metrorrhagia 49 19
development of menstrual cycle abnormalities. There-
Secondary amenorrhoea 39 15
fore, the clinical data of all girls who visited the ambu-
Hypermenorrhoea 39 15
lance for paediatric and adolescent gynaecology at
the university clinic for gynaecology and obstetric in Menorrhagia 36 14
Vienna between 2001 and 2008 because of menstrual Primary amenorrhoea 29 11
cycle abnormalities were used, expect those with pri-
Oligomenorrhoea 17 7
mary amenorrhoea (n 219). The following parameter
were analysed: age at the time of menarche, kind of Premenstrual syndrome 7 3

menstrual cycle abnormality (polymenorrhoea, Hypomenorrhoea 2 1

oligomenorrhoea, tempoanomaly, hypermenorrhoea, Polymenorrhoea 2 1
hypomenorrhoea, secondary amenorrhoea, dysmenor-

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than half (53%) of menstrual cycle abnormalities
(Tab. 1).
One hundred and seventy-nine female patients
(70%) suffered from only one menstrual cycle abnormal-
ity. Two coexistent menstrual cycle abnormalities existed
in 23% of the female patients, three abnormalities at the
same time by 5% of the girls. Three of the female patients
said to have four menstrual cycle abnormalities at the
same time and only one girl mentioned to suffer from
ve coeval menstrual abnormalities.
The majority of the female patients (40%) stated
that their menstrual cycle length differed every month.
The differences in the same person ranged from a few
days to several months. To this group belonged girls
with secondary amenorrhoea as a result from an oligo-
menorrhoea. In 24% of the girls, the menstrual cycle
length was between 23 and 28 days. The menstrual cycle
lasted for over 35 days in 44 female patients (17%), and
nine female patients (4%) said that their menstrual cycle
length lasted 2935 days. The menstrual cycle lasted
less than 15 days in 8 girls (3%). Five female patients
(2%) had a cycle length between 15 and 22 days.
In 146 girls (57%), an underlying cause of the
menstrual cycle abnormality could be found, the most
frequent was a hormonal one (24%). An organic cause
was present in 20% of the patients and a cause other
than hormonal or organic in 13%.
Cystic ovaries belonged to the organic causes in
this study.
Diabetes mellitus, hyperandrogenemia, hypogo-
nadism, thyroid hypofunction, hyperprolactinemia,
polycystic-ovary-syndrome as well as an elevated leu-
teinising hormone (LH) belonged to the hormonal
causes.
Cystic ovaries belonged to the organic causes in
this study. Obesity, anorexia nervosa, MayerRokitansky
KuesterHauser-Syndrome, posttraumatic status, psy-
chiatric diseases as well as coagulation dysfunction
belonged to the other causes.
The therapy consisted of hormonal prescriptions
in 54% of the cases. Thirty-three percentage of therapies
were entirely without hormonal prescriptions.
Hormonal pharmaceuticals used were oral con-
traceptives, drugs with gestagen, progesterone, as well
as combination products consisting of progesterone
and oestrogens.
If the menstrual cycle length was very irregular,
drugs with gestagen were taken for three months. Af-
terwards, a limited therapy with oral contraceptives for
together with the treatment of her menstrual cycle
abnormality.
Girls suffering from a dysmenorrhoea can be
treated with oral contraceptives exclusively. The con-
traction of the spiral arteries is the cause of the rejection
of the endometrium, and that creates pain. If there is no
development of the endometrium because of taking
oral contraceptives, the girls have no more pain.
To the non-hormonal therapy options belonged
analgesics (especially prostaglandin inhibitors) as well
as kinds of alternative medicine, capsules with sh oil,
magnesium, ferrite drugs (by anaemia) and the opera-
tion method after Veccietti in girls who suffered from a
primary amenorrhoea because of a MayerRokitansky
KuesterHauser-Syndrome.
Thirteen percentage of the girls needed no therapy.
Part 2: Matches between the age at menarche
and the development of menstrual cycle abnormalities
In this study, the most frequent age of getting the
menarche was eleven (28%). Only 2% of the patients
with menstrual cycle abnormalities had their menarche
at the age of 16 (Tab. 2). Therefore, the following
declaration could be executed: if a girl has to wait for
such a long time for her menarche, she would like to
have an examination at an ambulance for paediatric
endocrinology. Underlying causes can be hormonal
problems or genital malformations like a hymenal
atresia.
Girls with a menarche at the age of nine often
had tempoanomalies (57%). Those with their rst
Tab. 2: Frequency of age at menarche
(number of patients and percentage);
a D anni; numbers are rounded
Age at Frequency
menarche
Number Percentage
of patients
9a 7 3
10a 28 13
11a 62 28
12a 53 24
13a 38 17
14a 19 9
15a 7 3

another three months was added. 16a 5 2

A therapy with oral contraceptives was done at the Overall 219 100
request of the patient wishing to have a contraception

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Tab. 3: Matches between age at menarche and the development of a specic kind of menstrual cycle
abnormality; multiple answers possible; a D anni; numbers are rounded
Menstrual cycle Age at menarche
abnormality
9a 10a 11a 12a 13a 14a 15a 16a

Polymenorrhoea 0 (0%) 0 (0%) 1 (2%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

Oligomenorrhoea 1 (14%) 3 (11%) 3 (5%) 1 (2%) 2 (5%) 4 (21%) 1 (14%) 2 (40%)

Tempoanomaly 4 (57%) 9 (32%) 14 (23%) 18 (34%) 9 (24%) 4 (21%) 3 (43%) 0 (0%)

Hypermenorrhoea 0 (0%) 5 (18%) 15 (24%) 7 (13%) 8 (21%) 2 (11%) 1 (14%) 1 (20%)

Hypomenorrhoea 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (5%) 0 (0%) 1 (20%)

Secondary amenorrhoea 0 (0%) 1 (4%) 10 (16%) 9 (17%) 9 (24%) 5 (26%) 2 (29%) 2 (40%)

Dysmenorrhoea 3 (43%) 7 (25%) 18 (29%) 21 (40%) 17 (45%) 4 (21%) 1 (14%) 0 (0%)

Premenstrual syndrome 1 (14%) 1 (4%) 3 (5%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

Menorrhagia 2 (29%) 6 (21%) 12 (19%) 9 (17%) 3 (8%) 2 (11%) 1 (14%) 0 (0%)

Metrorrhagia 3 (43%) 12 (43%) 12 (19%) 10 (19%) 3 (8%) 4 (21%) 2 (29%) 0 (0%)

menstrual bleeding at the age of ten had mostly a
metrorrhagia (43%). Dysmenorrhoea was the main
menstrual cycle problem if the menarche occurred at
the age of eleven (29%), at the age of twelve (40%) as
well as at the age of 13 (45%). A menarche at the age of
14 leaded mostly to a secondary amenorrhoea (26%). If
the menarche occurs at the age of 15, the girls suffered
especially from tempoanomalies (43%). Female pa-
tients with their rst menstrual bleeding at the age of
16 had afterwards equally often an oligomenorrhoea
and a secondary amenorrhoea (40% each) (Tab. 3).
An underlying cause for the development of an
oligomenorrhoea into a secondary amenorrhoea is
e.g. a decit as well as an excess of important hor-
mones. Some of these girls suffered from a polycystic-
ovary-syndrome: 16% of the girls with a menarche at
the age of 14, 29% of those with their rst menstrual
bleeding at the age of 15 and 20% of the girls with a
menarche at the age of 16. Others suffered from a
thyroid hypofunction: this was the case in 5% of the
girls with a menarche at the age of 14.
Menstrual cycle abnormalities most often oc-
curred singly, to suffer from only one of them was
predominating in most of the menarche-groups
(66%). Girls with their menarche at the age of nine
suffered in 57% from two anomalies at the same time.

Tab. 4: Matches between age at menarche and coexistent menstrual cycle abnormalities
(number of patients and percentage); a D anni; numbers are rounded
Age at Coexistent menstrual cycle abnormalities
menarche
1 2 3 4 5

9a 2 (29%) 4 (57%) 0 (0%) 1 (14%) 0 (0%)

10a 15 (54%) 10 (36%) 3 (11%) 0 (0%) 0 (0%)

11a 43 (69%) 12 (19%) 6 (10%) 1 (2%) 0 (0%)

12a 37 (70%) 11 (21%) 3 (6%) 1 (2%) 1 (2%)

13a 26 (68%) 12 (32%) 0 (0%) 0 (0%) 0 (0%)

14a 13 (68%) 6 (32%) 0 (0%) 0 (0%) 0 (0%)

15a 4 (57%) 2 (29%) 1 (14%) 0 (0%) 0 (0%)

16a 4 (80%) 1 (20%) 0 (0%) 0 (0%) 0 (0%)

Overall 144 (66%) 58 (26%) 13 (6%) 3 (1%) 1 (0.46%)

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Only one girl who had her rst menstrual bleeding at than 50% of the girls received hormones if their rst
the age of 12 years lamented about fe menstrual cycle menstrual bleeding occurred at the age of nine (43%) or
abnormalities at the same time (Tab. 4). at the age of 14 (37%). This table shows that hormones
The therapy was in many cases a hormonal one have obtained a top ranking concerning the therapy of
(48%), as it is often necessary to gear into the hormonal menstrual cycle abnormalities (Tab. 5).
control cycle. In particular, gestagen, progesterone The underlying causes can be divided into organ-
and oestrogen drugs are used. Basically, girls with a ic, hormonal or others (see part 1).
menarche at the age of 16 were treated with hormones Underlying causes could be detected in 71% of the
(80%). The reason is that girls with a tardy rst girls with a menarche at the age of nine, most frequent
menstrual bleeding often suffer from hormonal were hormonal problems (43%). For girls, with a men-
disruptions. arche at the age of ten years, underlying causes for the
Girls with a menarche at the age of eleven were development of a menstrual cycle abnormality could be
treated with hormones the fewest of all (26%). Also, less detected in 64%, most frequently hormonal ones (32%).
For girls with a rst menstrual bleeding at the age of
eleven, underlying causes could be detected in 61%.
Tab. 5: Intake of hormones (percentage);
a D anni; numbers are rounded Here as well, hormonal problems were most frequent
(26%). Girls with menarche appeared at the age of
Intake of hormones twelve, had underlying causes detected in 53% of them.
Organic causes were most frequent (25%). In 50% of
Age at Number Percentage
girls with a menarche at the age of 13, an underlying
menarche of patients
cause could be detected. Hormonal problems were
9a 3 43 again the leading causes (21%). If the rst menstrual
bleeding appeared at the age of 14, organic and hor-
10a 16 57
monal causes as well as other ones were equally often
11a 16 26
responsible for the development of a menstrual cycle
12a 34 64 abnormality (16% each). In 47% of those girls, an un-
13a 22 58 derlying cause could be detected.
If the menarche appeared at the age of 15 the girls
14a 7 37
had mainly hormonal causes for the development of
15a 4 57 their cycle abnormalities (29%). In 57% of these girls
16a 4 80 underlying causes could be found.
All in all 106 48 If the rst menstrual bleeding appeared at the age
of 16, organic and hormonal causes were equally often

Tab. 6: Frequency of different underlying causes concerning to age at menarche (number of patients
and percentage); a D anni; numbers are rounded
Age at Causes
menarche
Organic Hormonal Other Overall

9a 1 (14%) 3 (43%) 1 (14%) 5 (71%)

10a 7 (25%) 9 (32%) 2 (7%) 18 (64%)

11a 14 (23%) 16 (26%) 8 (13%) 38 (61%)

12a 13 (25%) 10 (19%) 5 (9%) 28 (53%)

13a 6 (16%) 8 (21%) 5 (13%) 19 (50%)

14a 3 (16%) 3 (16%) 3 (16%) 9 (47%)

15a 1 (14%) 2 (29%) 1 (14%) 4 (57%)

16a 1 (20%) 1 (20%) 0 (0%) 2 (40%)

Overall 46 (21%) 52 (24%) 25 (11%) 123 (56%)

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responsible for the development of a menstrual cycle
abnormality (ever 20%). In only 40% of those girls an
underlying cause could be detected.
Overall, in 56% of the girls an underlying cause of
their menstrual cycle abnormality could be detected,
most frequently hormonal problems (24%).
Therefore, we could infer from this table that a
bigger part of menstrual cycle abnormalities had an
idiopathic cause (Tab. 6).
Discussion
This study will help to get a general idea of the
incidences of menstrual cycle abnormalities.
Most frequently, the girls suffered from dysmen-
orrhoea (29%), tempoanomaly (24%) and metrorrhagia
(19%). For 57%, it was possible to nd an underlying
cause. The most frequent one was hormonal (24%).
Other studies about menstrual cycle abnormali-
ties achieved similar results:
Bieniasz et al. detected that the polycystic-ovary-
syndrome is a very important factor concerning the
development of a menstrual cycle abnormality, and
that 63.2% of the girls who visited the ambulance for
endocrinology because of menstrual abnormalities in
Wroclaw had a hyperandrogenemia [7].
Wiksten-Almstrmer et al. said that menstrual
cycle abnormalities are often the result of a malfunc-
tion of the hypothalamic-pituitary-ovary-axis. 58% of
the 203 analysed girls suffered from a secondary ame-
norrhoea which was often the result of such a mal-
function. This malfunction was often associated with
anorexia nervosa. Forty-two percent of these girls
lament about oligomenorrhoea. Therefore often
hyperandrogenemia and polycystic-ovary-syndrome
were responsible [8].
Sharma et al. asserted that girls chiey suffer from
dysmenorrhoea. 67.2% of the 198 analysed girls were
adversely affected by this problem. Sharma et al. pro-
posed to construct a health programme where adoles-
cent girls could achieve advice concerning their
menstruation [9].
Quint and Smith demonstrated that menstrual
problems are common during adolescence due to slow
maturation of the hypothalamic-pituitary-ovarian axis
and can last 25 years after menarche. Evaluation and
intervention are necessary [10].
In our study, the therapy was in 54% a hormonal
one, because it is often necessary to gear into the
hormonal control cycle. Basically, girls with a menarche
at the age of 16 were treated with hormones (80%).
412 Art and Doerer Incidences of menstrual cycle abnormalities in adolescence
Fewest hormones are taken by girls with a menarche at
the age of eleven (26%).
Hormonal pharmaceuticals used were oral con-
traceptives, drugs with gestagen, progesterone, as well
as combination products consisting of progesterone
and oestrogens.
The ndings of a review done by Zahradnik et al.
support the use of non-steroidal anti-inammatory
drugs as a rst-line therapy for pain relief from dys-
menorrhoea in women without wish for contraception.
For women who wish contraception, combined oral
contraceptives are the preferential therapy for pain
relief from dysmenorrhoea as the additional non-con-
traceptive benet of pain relief from dysmenorrhoea is
not linked to additional risks, eliminates the risks asso-
ciated with taking non-steroidal anti-inammatory
drugs and is a more suitable long-term option. Recom-
mendations are made to strengthen the impact of
future trials through improved methodology [11].
Concerning the optimal treatment for dysmenor-
rhoea, there is a limited evidence for pain improvement
with the use of oral contraceptives (both low and
medium dose oestrogen) in women with dysmenor-
rhoea instead of using non-steroidal anti-inammatory
drugs. But there is no evidence of a difference between
different oral contraceptive preparations [12].
Furthermore, our study shows matches between
the age at menarche and the development of menstrual
cycle abnormalities. It shows that every age, at which
the menarche occurs, leads to a special kind of men-
strual cycle abnormality. Only if the menarche had set
in at the age of 16, two kinds were named with equal
frequency.
In this study the main time of attaining the men-
arche was eleven years (28%).
The ndings of a cross sectional study which was
done in 96 girls of age groups ranging from 11 to 17
years show that the median age of menarche was 12
years. There were 6.9% cases of oligomenorrhoea and
10% of hypomenorrhoea. Menorrhagia was seen in
6.2% of the girls. Spasmodic dysmenorrhoea was seen
in 67% of the female patients but the daily activity was
hampered in only 20%. It was seen that these school
girls needed education about the abnormalities of men-
struation so that they can differentiate the normal
phenomenon from abnormality [13].
Eighty-ve percent of reproductive-aged women
experience physical or emotional changes with their
menstrual cycle. Up to 40% of women are bothered
by menstrual cycle-related symptoms and conditions,
such as dysmenorrhoea. Effective treatment of cyclic
symptoms hinges on effective doctorpatient
Springer-Verlag 1516/2010 wmw

communication. Health care providers should remem-
ber to routinely ask questions about cycle-related
symptoms. This will encourage female patients to pro-
vide information and to participate in the management
of these symptoms, thus improving their productivity
and quality of life [14].
Concerning all of these interesting results, it was
an utmost concern to see how often different kinds of
menstrual cycle abnormalities are present in girls who
visit the ambulance for paediatric and adolescent gy-
naecology at the university clinic for gynaecology and
obstetrics in Vienna, and to get to know which under-
lying causes persist, and which therapy options are
used.
Otherwise, nobody should lose sight of the fact
that not behind every menstrual cycle abnormality a
kind of sickness is hidden. Often, the girls needed
simply time so that their body as well as their soul
could ease into this new reality.
It is important for all physicians to know that
menstrual cycle abnormalities are very often a problem
amongst girls and young women. They should treat
them carefully and should offer them advice as well as
provide them support.
Conict of interest
The authors declare that there is no conict of
interest.
wmw 1516/2010 Springer-Verlag Art and Doerer Incidences of menstrual cycle abnormalities in adolescence
themenschwerpunkt
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