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

406 Springer-Verlag 1516/2010 wmw


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stimulates the syntheses of androgens of the theca age of 16. Underlying causes can be anatomical aberra-
interna cells via production of testosterone and andro- tions or pervasive diseases like chromosomal anoma-
stenedione. Via the theca interna cells the androgens lies. In the secondary form, the girls already had a
are forwarded to the granulosa cells and there they are menstrual bleeding before, but it failed to appear for
altered into estradiole via the FSH-dependent aroma- at least six months. Causes therefore are diseases like
tises. Because of the increasing GnRH-pulse activity of problems with the thyroid gland, diabetes mellitus,
the hypothalamus the synthesis of FSH can increase hormonal anomalies like hyperandrogenemia, polycys-
rapidly until a sufcient concentration of estradiole, tic-ovary-syndrome or hyperprolactinemia, as well as a
which is needed for the development of the endome- gain in weight, an ovarian insufciency, stress, a heavily
trium, is achieved. The rst deprivation of estradiole physical strain as well as a problem in the hypothalam-
leads to a withdrawal bleeding which is the so-called ic-pituitary-ovary-axis.
menarche [1]. A clear differentiation between the primary and
The main gynaecological problems amongst ado- the secondary form is the fact that a girl with the
lescent girls are menstrual cycle abnormalities. secondary form has an uterus and a production of
Slap detected that problems associated with men- oestrogen. Of course, it is necessary to exclude the
struation affect 75% of adolescent females and are a existence of a gravity before one makes the diagnosis
leading reason for visits to physicians [2]. of a secondary amenorrhoea.
Drosdozol and Skrzypulec published in 2008 that The term hypermenorrhoea means a very strong
the main problem in paediatric and adolescent gynae- menstrual bleeding with a loss of blood of more than
cology is the dysmenorrhoea. Adolescent girls suffer 80 ml (normally a women loses circa 3040 ml blood
especially from the primary form. They have normal during her menstruation).
menstrual cycles and no pathologies of the pelvis. Only The term menorrhagia means a very strong and
10% of the girls are affected by the secondary form. The durable menstrual bleeding. Non-hormonal drugs used
main underlying causes of the secondary form were are mostly prostaglandin-inhibitors. The hormonal
endometrioses, inammatory pelvic diseases, congeni- substance in use is basically progesterone.
tal mullerian malformations as well as ovary cysts [3]. Hypomenorrhoea is a very light bleeding. It oc-
Harel also asserted that dysmenorrhoea is the curs especially upon taking oral contraceptives.
most common gynaecologic complaint amongst ado- Dysmenorrhoea is the medical term for a painful
lescent females. It is usually primary, only 10% of the menstruation. This kind of menstrual cycle abnormal-
girls suffer from the secondary form with pelvic abnor- ity appears especially in adolescent girls [5]. In the
malities such as endometrioses or uterine anomalies. primary dysmenorrhoea, there are no pathologies of
Potent prostaglandins and leukotrienes play an the pelvis. The symptoms start with the menarche or
important role in generating the symptoms of dysmen- between six and twelve months afterwards. The pri-
orrhoea. Non-steroidal anti-inammatory drugs mary dysmenorrhoea is characterised by spastic ab-
(NSAIDs) are the most common pharmacological treat- dominal pain, which radiates to the back. This pain
ments for dysmenorrhoea. Adolescents with symptoms starts a few hours before the menstrual bleeding be-
that do not respond to treatment with NSAIDs for three gins and continues for about one to three days. There
menstrual periods should be offered hormonal treat- are often additional gastrointestinal or vascular pro-
ment such as combined oestrogen-progesteron oral blems like nausea, vomiting, diarrhoea, headache,
contraceptives for three menstrual cycles. Adolescents fatigue, hufness as well as syncope. Especially girls
with dysmenorrhoea who do not respond to this treat- and young women, who have not given birth yet, suffer
ment should be evaluated for secondary causes of from this kind of menstrual cycle abnormality. The
dysmenorrhoea [4]. grievances often disappear when the woman is preg-
nant for the rst time.
The synthesis of prostaglandin in the uterus is
Denition of terms used to describe controlled by progesterone. Cycles without an ovula-
menstrual cycle abnormalities tion are not painful, because the progesterone level
cannot increase without the corpus luteum. Prostaglan-
The term amenorrhoea stands for the abstinence din F2 alpha and E2 are connected to dysmenorrhoea.
of menstruation. Amenorrhoea can be divided into a For the therapy, prostaglandin-inhibitors are used.
primary and a secondary form. The primary form Pathologies of the pelvis are predominant in the
means a menarche which has not occurred until the secondary form of dysmenorrhoea. To be able to make

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a correct diagnosis, a laparoscopy is needed. A frequent rhoea, premenstrual syndrome, menorrhagia as well as
cause is an endometriosis [6]. metrorrhagia), amount of coexisting menstrual cycle
Contrary to the dysmenorrhoea, a premenstrual abnormalities, causes (hormonal, organic, others) as
syndrome means an existing pain in the luteal phase, well as therapy options (hormonal, non-hormonal,
which is the second half of the menstrual cycle, which none). Girls with a menarche between nine and 16 years
disappears at the beginning of the menstrual bleeding. were enclosed in the study. All clinical data were sta-
The term dysfunctional bleeding stands for men- tistically analysed with Excel Version 2000.
orrhagia which is a very strong, painful and durable This retrospective analysis was intended to de-
bleeding as well as metrorrhagia which is the medical scribe the matches between the age at menarche and
term for bleedings which appear at every time of the the development of menstrual cycle abnormalities in
menstrual cycle, so-called spotting. these female patients.
Oligomenorrhoea means a cycle length of over All of the girls in this study had gynaecological
35 days. Polymenorrhoea is the medical term for a problems, which ranged from painful, very strong men-
menstrual cycle with less than 2022 days. Many of these struation bleedings to primary amenorrhoea and were
abnormalities express a cycle without ovulation [6]. carefully gynaecologically examined.
The term tempoanomaly is used in this study to If the physician had a suspicion that the girl could
describe cycles with a cycle length that is monthly suffer from a hormonal dysfunction, a hormonal anal-
different. The range reaches from a few days to several ysis was requested. Hormonal problems like hyperan-
months in the same female patient. 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-

408 Art and Doerer Incidences of menstrual cycle abnormalities in adolescence Springer-Verlag 1516/2010 wmw
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than half (53%) of menstrual cycle abnormalities together with the treatment of her menstrual cycle
(Tab. 1). abnormality.
One hundred and seventy-nine female patients Girls suffering from a dysmenorrhoea can be
(70%) suffered from only one menstrual cycle abnormal- treated with oral contraceptives exclusively. The con-
ity. Two coexistent menstrual cycle abnormalities existed traction of the spiral arteries is the cause of the rejection
in 23% of the female patients, three abnormalities at the of the endometrium, and that creates pain. If there is no
same time by 5% of the girls. Three of the female patients development of the endometrium because of taking
said to have four menstrual cycle abnormalities at the oral contraceptives, the girls have no more pain.
same time and only one girl mentioned to suffer from To the non-hormonal therapy options belonged
ve coeval menstrual abnormalities. analgesics (especially prostaglandin inhibitors) as well
The majority of the female patients (40%) stated as kinds of alternative medicine, capsules with sh oil,
that their menstrual cycle length differed every month. magnesium, ferrite drugs (by anaemia) and the opera-
The differences in the same person ranged from a few tion method after Veccietti in girls who suffered from a
days to several months. To this group belonged girls primary amenorrhoea because of a MayerRokitansky
with secondary amenorrhoea as a result from an oligo- KuesterHauser-Syndrome.
menorrhoea. In 24% of the girls, the menstrual cycle Thirteen percentage of the girls needed no therapy.
length was between 23 and 28 days. The menstrual cycle
lasted for over 35 days in 44 female patients (17%), and Part 2: Matches between the age at menarche
nine female patients (4%) said that their menstrual cycle and the development of menstrual cycle abnormalities
length lasted 2935 days. The menstrual cycle lasted In this study, the most frequent age of getting the
less than 15 days in 8 girls (3%). Five female patients menarche was eleven (28%). Only 2% of the patients
(2%) had a cycle length between 15 and 22 days. with menstrual cycle abnormalities had their menarche
In 146 girls (57%), an underlying cause of the at the age of 16 (Tab. 2). Therefore, the following
menstrual cycle abnormality could be found, the most declaration could be executed: if a girl has to wait for
frequent was a hormonal one (24%). An organic cause such a long time for her menarche, she would like to
was present in 20% of the patients and a cause other have an examination at an ambulance for paediatric
than hormonal or organic in 13%. endocrinology. Underlying causes can be hormonal
Cystic ovaries belonged to the organic causes in problems or genital malformations like a hymenal
this study. atresia.
Diabetes mellitus, hyperandrogenemia, hypogo- Girls with a menarche at the age of nine often
nadism, thyroid hypofunction, hyperprolactinemia, had tempoanomalies (57%). Those with their rst
polycystic-ovary-syndrome as well as an elevated leu-
teinising hormone (LH) belonged to the hormonal
Tab. 2: Frequency of age at menarche
causes. (number of patients and percentage);
Cystic ovaries belonged to the organic causes in a D anni; numbers are rounded
this study. Obesity, anorexia nervosa, MayerRokitansky
KuesterHauser-Syndrome, posttraumatic status, psy- Age at Frequency
chiatric diseases as well as coagulation dysfunction menarche
Number Percentage
belonged to the other causes.
of patients
The therapy consisted of hormonal prescriptions
in 54% of the cases. Thirty-three percentage of therapies 9a 7 3
were entirely without hormonal prescriptions. 10a 28 13
Hormonal pharmaceuticals used were oral con-
11a 62 28
traceptives, drugs with gestagen, progesterone, as well
as combination products consisting of progesterone 12a 53 24
and oestrogens. 13a 38 17
If the menstrual cycle length was very irregular,
14a 19 9
drugs with gestagen were taken for three months. Af-
terwards, a limited therapy with oral contraceptives for 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 e.g. a decit as well as an excess of important hor-
metrorrhagia (43%). Dysmenorrhoea was the main mones. Some of these girls suffered from a polycystic-
menstrual cycle problem if the menarche occurred at ovary-syndrome: 16% of the girls with a menarche at
the age of eleven (29%), at the age of twelve (40%) as the age of 14, 29% of those with their rst menstrual
well as at the age of 13 (45%). A menarche at the age of bleeding at the age of 15 and 20% of the girls with a
14 leaded mostly to a secondary amenorrhoea (26%). If menarche at the age of 16. Others suffered from a
the menarche occurs at the age of 15, the girls suffered thyroid hypofunction: this was the case in 5% of the
especially from tempoanomalies (43%). Female pa- girls with a menarche at the age of 14.
tients with their rst menstrual bleeding at the age of Menstrual cycle abnormalities most often oc-
16 had afterwards equally often an oligomenorrhoea curred singly, to suffer from only one of them was
and a secondary amenorrhoea (40% each) (Tab. 3). predominating in most of the menarche-groups
An underlying cause for the development of an (66%). Girls with their menarche at the age of nine
oligomenorrhoea into a secondary amenorrhoea is 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 Fewest hormones are taken by girls with a menarche at
abnormality (ever 20%). In only 40% of those girls an the age of eleven (26%).
underlying cause could be detected. Hormonal pharmaceuticals used were oral con-
Overall, in 56% of the girls an underlying cause of traceptives, drugs with gestagen, progesterone, as well
their menstrual cycle abnormality could be detected, as combination products consisting of progesterone
most frequently hormonal problems (24%). and oestrogens.
Therefore, we could infer from this table that a The ndings of a review done by Zahradnik et al.
bigger part of menstrual cycle abnormalities had an support the use of non-steroidal anti-inammatory
idiopathic cause (Tab. 6). 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
Discussion contraceptives are the preferential therapy for pain
relief from dysmenorrhoea as the additional non-con-
This study will help to get a general idea of the traceptive benet of pain relief from dysmenorrhoea is
incidences of menstrual cycle abnormalities. not linked to additional risks, eliminates the risks asso-
Most frequently, the girls suffered from dysmen- ciated with taking non-steroidal anti-inammatory
orrhoea (29%), tempoanomaly (24%) and metrorrhagia drugs and is a more suitable long-term option. Recom-
(19%). For 57%, it was possible to nd an underlying mendations are made to strengthen the impact of
cause. The most frequent one was hormonal (24%). future trials through improved methodology [11].
Other studies about menstrual cycle abnormali- Concerning the optimal treatment for dysmenor-
ties achieved similar results: rhoea, there is a limited evidence for pain improvement
Bieniasz et al. detected that the polycystic-ovary- with the use of oral contraceptives (both low and
syndrome is a very important factor concerning the medium dose oestrogen) in women with dysmenor-
development of a menstrual cycle abnormality, and rhoea instead of using non-steroidal anti-inammatory
that 63.2% of the girls who visited the ambulance for drugs. But there is no evidence of a difference between
endocrinology because of menstrual abnormalities in different oral contraceptive preparations [12].
Wroclaw had a hyperandrogenemia [7]. Furthermore, our study shows matches between
Wiksten-Almstrmer et al. said that menstrual the age at menarche and the development of menstrual
cycle abnormalities are often the result of a malfunc- cycle abnormalities. It shows that every age, at which
tion of the hypothalamic-pituitary-ovary-axis. 58% of the menarche occurs, leads to a special kind of men-
the 203 analysed girls suffered from a secondary ame- strual cycle abnormality. Only if the menarche had set
norrhoea which was often the result of such a mal- in at the age of 16, two kinds were named with equal
function. This malfunction was often associated with frequency.
anorexia nervosa. Forty-two percent of these girls In this study the main time of attaining the men-
lament about oligomenorrhoea. Therefore often arche was eleven years (28%).
hyperandrogenemia and polycystic-ovary-syndrome The ndings of a cross sectional study which was
were responsible [8]. done in 96 girls of age groups ranging from 11 to 17
Sharma et al. asserted that girls chiey suffer from years show that the median age of menarche was 12
dysmenorrhoea. 67.2% of the 198 analysed girls were years. There were 6.9% cases of oligomenorrhoea and
adversely affected by this problem. Sharma et al. pro- 10% of hypomenorrhoea. Menorrhagia was seen in
posed to construct a health programme where adoles- 6.2% of the girls. Spasmodic dysmenorrhoea was seen
cent girls could achieve advice concerning their in 67% of the female patients but the daily activity was
menstruation [9]. hampered in only 20%. It was seen that these school
Quint and Smith demonstrated that menstrual girls needed education about the abnormalities of men-
problems are common during adolescence due to slow struation so that they can differentiate the normal
maturation of the hypothalamic-pituitary-ovarian axis phenomenon from abnormality [13].
and can last 25 years after menarche. Evaluation and Eighty-ve percent of reproductive-aged women
intervention are necessary [10]. experience physical or emotional changes with their
In our study, the therapy was in 54% a hormonal menstrual cycle. Up to 40% of women are bothered
one, because it is often necessary to gear into the by menstrual cycle-related symptoms and conditions,
hormonal control cycle. Basically, girls with a menarche such as dysmenorrhoea. Effective treatment of cyclic
at the age of 16 were treated with hormones (80%). symptoms hinges on effective doctorpatient

412 Art and Doerer Incidences of menstrual cycle abnormalities in adolescence Springer-Verlag 1516/2010 wmw
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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 413