Menstrual Irregularities

One of the most common complaints of adolescent girls is irregular, profuse menstruation, called dysfunction uterine bleeding (DUB). The most common cause for DUB is when a woman's ovaries don't release an egg. Not ovulating causes her period to come later or earlier, and heavier than usual. Young girls commonly experience DUB because their menstrual cycles have not yet settled into a pattern and ovulation isn't occurring. Older adolescents may not ovulate with stress or illness.

The most common menstrual irregularities include:

• Amenorrhea: absence of menstrual periods
• Oligomenorrhea: Infrequent menstrual periods that occur more than 35 days apart
• Menorrhagia: Heavy menstrual periods
• Prolonged menstrual bleeding: Bleeding that exceeds eight days
• Dysmenorrhea: painful menstrual periods

If your daughter has dysfunctional uterine bleeding, she may notice:

• Bleeding or spotting from the vagina occurs between periods
• Menstrual periods may be less than 21 days or more than 45 days apart
• The time between each cycle changes each time
• The need to change her pad or tampon during the night or every few hours
• Bleeding that lasts for more than seven days

Conditions that cause a lack of ovulation could be the culprit of menstrual irregularities or dysfunctional uterine bleeding. Common causes include:

• Eating disorders
• Weight changes
• Athletic competition
• Chronic illnesses
• Drug abuse
• Endocrine disorders
• Polycystic ovary syndrome (PCOS)

If your daughter has a vertical or complete vaginal septum, she has two openings to her vagina, and this may prevent one tampon from stopping the flow of blood.

If your daughter is experiencing irregular and profuse menstrual bleeding, her physician will perform a thorough history. A pelvic examination may be performed to rule out the possibility of pregnancy disorders or pelvic infections, if applicable. In cases of excessive bleeding, a Hematocrit blood test will determine the amount of blood loss.

During the first few years of a girl's menstrual cycle, she may not benefit from treatment unless heavy blood loss causes anemia. A physician may recommend an iron supplement for the anemia.

Oral birth control pills or other hormonal treatments are often used to regulate or temporarily stop the menstrual cycle.

The Reproductive Endocrinology and PCOS Program and Division of Gynecology at Boston Children’s Hospital recognize the special needs of adolescents. Our experienced physicians evaluate and treat patients with a wide range of menstrual irregularities.

The following guide may be helpful: Puberty and Your Menstrual Cycle: A Guide for Teens.