Menstrual Disorders In A Paediatric And Adolescent .

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O R I G I N A LA R T I C L EPW ChungSymphorosa SC ChanKW YiuTerence TH LaoTony KH ChungMenstrual disorders in a Paediatric and AdolescentGynaecology Clinic: patient presentations andlongitudinal 國衡ObjectiveDesignProspective cohort study.SettingPaediatric and Adolescent Gynaecology Clinic, Hong Kong.ParticipantsKey wordsAdolescent; Amenorrhea; Menstruationdisturbances; Polycystic ovary syndromeHong Kong Med J 2011;17:391-7Department of Obstetrics andGynaecology, The Chinese University ofHong Kong, Prince of Wales Hospital,Shatin, Hong KongPW Chung, MB, ChBSSC Chan, MB, ChB, FHKAM (Obstetrics andGynaecology)KW Yiu,TTH Lao,To study the presentations, diagnoses, and outcomes inadolescents with menstrual disorders.A total of 577 adolescents aged 14 to 19 years.Main outcome measuresThe presentations and diagnoses of adolescents with menstrualdisorders were reviewed and their menstrual outcomesdetermined by a telephone survey.ResultsIn all, 47% presented with menorrhagia, prolonged menstruation,and short menstrual cycles; 27% had secondary amenorrhoea,12% had dysmenorrhoea, 11% had oligomenorrhoea, and 3%had primary amenorrhoea. Significant diagnoses includedcongenital genital tract anomalies, premature ovarian failure,anorexia nervosa, and polycystic ovarian syndrome. Polycysticovarian syndrome was diagnosed in 16% of the cohort. In all,24% of these 577 patients had abnormal menstrual cycles 4years later. Direct logistic regression analysis indicated a cyclelength of more than 35 days at presentation (adjusted oddsratio 2.8; 95% confidence interval, 1.8-4.5), previous diagnosisof polycystic ovarian syndrome (adjusted odds ratio 2.0; 95%confidence interval, 1.1-3.4), and current body mass index of23 kg/m2 or higher (adjusted odds ratio 1.8; 95% confidenceinterval, 1.0-3.0) were risk factors for persistently long menstrualcycle exceeding 35 days. Adolescents who were screened outwith a definitive diagnosis after initial assessment were at lowrisk of persistently long menstrual cycles at follow-up (adjustedodds ratio 0.3; 95% confidence interval, 0.1-0.8).ConclusionsAdolescent menstrual disorders should not be ignored.Long cycle, diagnosis of polycystic ovarian syndrome at firstconsultation, and a current body mass index of 23 kg/m2 orhigher were statistically associated with persistent problems.New knowledge added by this study Up to 16% of Hong Kong adolescent girls presented with menstrual disorders suffered frompolycystic ovarian syndrome (PCOS) in our study. Long cycle lengths at first consultation, diagnosis of PCOS at first consultation, and bodymass index of 23 kg/m2 at follow-up were associated with persistently long menstrual cyclelength ( 35 days). Adolescents who were screened out for a definitive diagnosis after initialassessment were at low risk of persistently long menstrual cycles at follow-up.Implications for clinical practice or policy Those adolescents with oligomenorrhoea or amenorrhoea after 2 years following menarcheshould be investigated. Adolescent girls who fulfil diagnosis of PCOS should have long-term follow-up. Oligomenorrhoeic adolescents who are screened out for a definitive diagnosis after initialassessment should be managed conservatively.MB, ChB, FHKAM (Obstetrics andGynaecology)MD, FHKAM (Obstetrics and Gynaecology)TKH Chung,MD, FRCOG ad eundemCorrespondence to: Dr SSC ChanEmail: disorders such as menorrhagia, dysmenorrhoea, and abnormal menstrualcycle length are common in adolescents. The majority of such disorders are usually selfHong Kong Med J Vol 17 No 5 # October 2011 # www.hkmj.org391

# Chung et al 比數比 ��巢綜合症的病史(調整比數比 ��指數為23 kg/m2或以上(調整比數比 �的風險屬於低(調整比數比 ��達23 kg/m2或以上。proportion of subjects with eating disorders.6Although most adolescents had normal menstrualcycle 2 years after menarche, two thirds of thosewhose oligomenorrhoea persisted for more than2 years still had oligomenorrhoea 10 years later,2,7though the causes of their menstrual disorderswere remained unknown. In this study, we aimed toidentify the causes of the menstrual disorders andeventual menstrual outcomes of such adolescents, asinformation on this subject is limited.At presentation, a clinician has to identify thosewho are at substantial risk of persistent problems andrequire long-term management, but at present howsuch information is to be obtained is not adequatelydefined. A longitudinal observational study of apopulation-based cohort was the best approach toshedding light on this topic, but studies to pursuethese questions have been relatively uncommon.3,5,8An accredited, specialised Paediatric andAdolescent Gynaecology Clinic (PAGC) was setup in our institute to cater for adolescents withgynaecological problems. The PAGC is a tertiarycentre that receives referrals mainly from otherdepartments (61%) of three different hospitalsin the same cluster (Department of Paediatricsand Adolescent Medicine, and the Accident andEmergency Department); whereas 31% of referralswere from the public screening centres, with theremaining 8% from general practitioners.Evaluation and investigation of adolescentspresenting with menstrual abnormalities wasconducted in a standardised manner. We performeda telephone questionnaire survey to investigate theoutcomes of adolescents who presented to the PAGCfor menstrual disorders. In this cohort of adolescentslimiting as most are due to the immaturity of the aged 14 to 19 years, we also investigated risk factorshypothalamic-pituitary axis, but some are attributable for persistently abnormal significant pathology such as premature ovarianfailure and polycystic ovarian syndrome (PCOS).These conditions may have considerable physical Methodsand psychological consequences.1 It has also been Since the establishment of the PAGC, it hassuggested that those with persistent anovulatory been managed by a dedicated team of specialistmenstrual patterns have an increased risk for gynaecologists with rotating resident trainees inendometrial carcinoma.2 In a small number of cases, attendance. Patient assessment and management wasother significant pathology, such as genital tract according to an evidence-based protocol that wasabnormality, may also be discovered.consistent with established practice. Information onIn some school surveys, the prevalence ofvarious menstrual

menstrual cycle patterns and cycle length, medical and social history, and physical examination findings was routinely obtained at the first consultation. Menorrhagia was defined as the subjective complaint of heavy menstrual flow. Short menstrual cycle

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