Clinical Guidelines and Standards · Guidelines by Clinical Area
RRM Academy Synopsis
ACOG says the menstrual cycle is a vital sign in adolescents
ACOG says doctors should track the menstrual cycle as a vital sign in girls and teens. Its 2015 committee opinion, endorsed by the American Academy of Pediatrics, describes normal cycles and lists patterns that may need a closer look.
Key Findings
- The median age at menarche (first period) has remained relatively stable at 12 years to 13 years in developed countries where nutrition is good.
- 98% of females will have had menarche by age 15 years.
- In the early years after menarche, 90% of cycles fall within 21–45 days. By the third year after menarche, 60–80% of cycles are 21–34 days long.
- Among the listed abnormalities are periods 90 days apart, even for one cycle, and periods that last more than 7 days.
- For girls who have begun menstruating, the committee advises asking about the first day of the last period and the pattern of bleeding at every preventive care or comprehensive visit.
Interpretation
A committee opinion is a consensus statement from a professional society. The authors draw on earlier published studies and report no new data. The median age at menarche applies to well-nourished populations in developed countries. The authors write that spotting abnormal patterns in adolescence "may" help find health concerns earlier. They give no outcome data showing that tracking the cycle improves health later. The committee suggests charting may help when a menstrual history is vague.
RRM Context
Charting the cycle is central to restorative reproductive medicine. Cycle notes point to causes underneath a symptom. The opinion makes asking about the cycle routine at teen visits, and suggests charting when the history is vague. Its causes of abnormal bleeding include thyroid disease, eating disorders and hormonal contraception.
Abstract
Despite variations worldwide and within the U.S. population, median age at menarche has remained relatively stable-between 12 years and 13 years-across well-nourished populations in developed countries. Environmental factors, including socioeconomic conditions, nutrition, and access to preventive health care, may influence the timing and progression of puberty. A number of medical conditions can cause abnormal uterine bleeding, characterized by unpredictable timing and variable amount of flow. Clinicians should educate girls and their caretakers (eg, parents or guardians) about what to expect of a first menstrual period and the range for normal cycle length of subsequent menses. Identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood. It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient. By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers.
Topics
Keywords
Adolescent, Adolescent Health Services, Child, Female, Health Status Indicators, Humans, Menarche/physiology, Menstrual Cycle/physiology, Menstruation/physiology, Menstruation Disturbances/diagnosis/etiology, Patient Education As Topic, Preventive Health Services/methods, Vital Signs