Article on Teenage Problems

The developmental changes that take in a girl in the age group between 13 and 18 are often referred to as adolescence. The girl needs to adjust to the fast paced physical and emotional changes. They definitely deserve the attention. Most of them, out of fear, anxiety or may be embarrassment, do not come forward to discuss their problems. Educating them regarding the menstrual cycle, accelerated growth, sexually transmitted diseases will go along way in protecting the health of teenagers.

 

WHAT IS PUBERTY?

The cascade of events that occur around 13 to 14 years of age e.g. breast development, pubic and axillary hair, growth in height and menstruation put together is often referred to as puberty. In short the girl is ready for procreation. The menstruation begins between the age group of 12.5 to 14.5. This is often the last event in the chronology of puberty.

DELAYED PUBETRY

What is delayed puberty?

Any delay in appearance of secondary sexual development beyond the age of 15 and failure to start menses in the natural course after 16 years is termed as delayed puberty.

What is the treatment?

You need to see your gynecologist. Let him/her decide what is to be done. Usually your doctor will assess the girl with three sets of diagnosis in mind.

a)Normal sexual development

b)Poor or absent sexual development

c)Heterosexual development i.e. whether she has any manly features

In the first group, mainly it is the outflow obstruction i.e. imperforate hymen or the vaginal septum and rarely resistant ovarian syndrome. For that your doctor might ask for some blood tests like FSH and LH.

In the second group, it is the constitutional delay for which wait and watch policy will apply. Gonadal dysgenesis & hypothalamo pituitary failure are some other causes. Estimation of FSH, LH, thyroid function tests, skull x-ray CT scan are few of the investigations, which will help the gynecologist to come to a conclusion.

In the last of the lot, chromosomal abnormality and congenital adrenal hyperplasia need to be ruled out. 

IS YOUR DAUGHTER GETTING HEAVY MENSES?

First few menstrual cycles can be anovulatory i.e. they do not produce an egg in those cycles. So the inside part of the uterus (endometrium) grows unopposed causing excess bleeding. Amount and duration of flow is increased during these episodes.

Investigations usually recommended are the blood counts and coagulation studies. Expensive RIA tests are often unnecessary.

TREATMENT OPTIONS

ØReassurance

ØNonhormonal: antiprostaglandins like mefanamic acid, naproxin hydrochlorides can be tried initially. Diet recommendation with high protein intake is useful.

ØHormonal: Progestogens, in cases of excess bleeding causing fall in HB%, progesterone therapy is advised.

ØSurgical: diagnostic curettage may be required in cases of failure of hormonal therapy.

IS SHE GETTING IRREGULAR MENSES?

If one gets the menses every 28 days and lasts for 4 days, it is normal though the range is between 21 to 35 days. The irregularity in the initial couple of years is because of anovulation i.e. the ovaries do not produce eggs. Reassurance is all that is required as it is self-limiting factor.

If the cycles become irregular after normal initial pattern one may need to investigate.

Too much of exercise and or crash dieting can be a causative factor.

Consultation with the gynecologist is worthwhile at this stage, as he/she may have to rule out some conditions, which cause this abnormality. He may advise some RIA tests e.g. serum Prolactin, FSH/LH, Thyroid function tests. Ultrasonography can be a useful investigation

WHITE DISCHARGE

Teenagers some times present with vaginal discharge. This can be physiological i.e. normal and does not require any treatment. If the discharge is associated with itching or it is foul smelling, it requires treatment. Sexual activity or abuse needs to be enquired into before starting the therapy.

Treatment includes proper attention to the hygiene and clothing, local douches, antimicrobials, etc.