Common Menstrual Complaints

Menstruation is a normal part of puberty in adolescents, and is often accompanied by mild discomfort, irritability, abdominal cramps and fatigue. For some young people however, menstrual complaints are more severe and can include debilitating pain, irregular bleeding, abnormal vaginal discharge, and a host of other symptoms.

Common menstrual-related conditions include:

To better understand normal ovulation and menstruation, see Menstrual Cycle: An Overview.

Heavy menstrual bleeding

Heavy or prolonged menstrual bleeding can be a common concern — especially for adolescents who are just learning what a “normal” menstrual cycle is for them. Symptoms include soaking through one or more sanitary pads of tampon every hour for several consecutive hours, needing to wake up to change sanitary protection during the night, bleeding that lasts longer than a week, and symptoms of anemia like tiredness and fatigue.

While most young people will not experience blood loss severe enough to be defined as heavy menstrual bleeding, it can be a symptom of serious conditions such as uterine structural abnormalities, hormonal imbalances, bleeding disorders or infection.

Irregular menstrual bleeding

Irregular periods can be common — especially during adolescence. Menstrual bleeding is considered abnormal if it lasts eight days or more, occurs more frequently than every 21 days or less frequently than every 45 days.

A young person’s menstrual cycle is affected by a number of factors including diet, exercise, medical illness and stress. Often these lifestyle factors can be changed so they don’t affect a young person’s period.

If someone has irregular menstrual periods for more than a few cycles, it could indicate a more serious condition such as hyperthyroidism, hypothyroidism, uncontrolled diabetes or elevated testosterone levels, among others. Other possible causes of irregular menstrual bleeding include hormone imbalances (which could be related to hormonal medications) and medications to treat other conditions.

Adolescents with irregular menstrual bleeding should be examined by an Adolescent Medicine specialist who can determine the cause of the irregularity and recommend treatment if needed.

Absent menstrual periods

Amenorrhea is a menstrual condition characterized by absent menstrual periods for three or more monthly menstrual cycles. Some reasons for amenorrhea are normal occurrences during a person’s life — pregnancy and breastfeeding, for example. However, amenorrhea can also be a sign of a medical problem, or a side effect of certain medications.

If a teen has not started menstruating by age 15, or their menstrual cycle has stopped or is irregular, they should be examined by a doctor with expertise diagnosing and treating young people with menstrual issues.

Frequent menstrual cramps and pain

Dysmenorrhea is a menstrual condition marked by severe and frequent menstrual cramps and pain. The condition can be lifelong or may be caused by another medical condition such as pelvic inflammatory disease (PID) or endometriosis.

While dysmenorrhea can affect any teen, the risk increases for those who smoke, drink alcohol during their period, are overweight, and those who start menstruating before age 11.

Painful menstrual cramps can be debilitating, affect daily activities, and may be a symptom of a more serious condition. For these reasons, it’s important to be assessed by a doctor with expertise treating young people with menstrual issues.

Premenstrual syndrome

Premenstrual syndrome, or PMS as it’s commonly called, is a group of unpleasant or uncomfortable symptoms that may occur before or during a person’s menstrual cycle. Nearly 85 percent of people experience at least one PMS symptom during their reproductive years. Symptoms can include physical issues, such as abdominal cramps, bloating, headache and acne, and psychological symptoms, such as irritability, lethargy and depression.

Symptoms of PMS may resemble other conditions and medical problems, so it’s important for your adolescent to be assessed by clinicians with expertise treating young people with menstrual issues.

Abnormal vaginal discharge

During puberty, an adolescent’s body begins to change. Along with outward physical differences, they may notice a discharge from their vagina and become concerned. While it is normal and healthy for young people’s bodies to produce clear or white discharge from the vagina, any change in the amount, color or smell of vaginal discharge could indicate a vaginal infection and should be properly assessed by an Adolescent Medicine specialist. Learn more about the types of abnormal vaginal discharge.

Pelvic pain

Severe pelvic pain or pain in the lower abdomen is not normal for adolescents. In many cases, the pain is caused by sexually transmitted infections — like chlamydia or gonorrhea — in the female’s reproductive organs. This infection is called to pelvic inflammatory disease (PID), which is treated with antibiotics.

If left untreated, PID can worsen and lead to fertility issues and ongoing pelvic pain.

Vaginal itching, redness and swelling

Vaginal itching, redness and swelling can be symptoms of a large number of conditions, so it’s important to consult with a healthcare provider if symptoms last more than a few days. In many cases, these distressing symptoms can be caused by vulvovaginitis, an inflammation of the vulva, the skin outside the vagina. Any person can develop vulvovaginitis, including those who have not reached puberty.

Where to get treatment

The Adolescent Medicine program at Children’s Hospital of Philadelphia (CHOP) provides evaluation, treatment and support for adolescents and young adults. Our multidisciplinary team of doctors and nurses work to provide family-centered care with compassion and respect, and meeting the individual needs of each patient and their family.

To help young people learn to develop the skills they need to be responsible for their own health, we usually ask to spend time alone with our patients during each visit. This helps young people become comfortable talking with their healthcare providers about their concerns. It also allows patients to ask questions that may be more difficult to express in front of their parents and caregivers.

Reviewed by Kenisha Campbell, MD, MPH

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