Main Article Content
Adolescents, menstrual blood loss, menstrual disorders, hypomenorrhea, menstrual health.
Abstract. Menstrual health affects a large number of women throughout reproductive life since adolescence. Knowledge of the duration and variation of the menstrual cycle is necessary for patient education and to identify deviations from normal to guide clinical evaluation. The average duration of menstrual flow is between 4 to 6 days, with anormal range from 2 up to 8 days ; the mean blood loss per menstrual cycle is 25- 30 mL. In general, descriptive data falling outside the normal range are considered to be indicative of menstrual disorders. Although the American Academy of Pediatrics and American College of Obstetricians and Gynecologists advocate for clinicians to consider the menstrual cycle as a vital sign in adolescents, the identification of subjects with hypomenorrhea is neither well defined nor routinely practiced. In this paper we have summarized the published prevalence of hypomenorrhea (lighter and/or shorter menstrual bleeding) in adolescents and youths in different countries and report the personal experience in four adolescents.
2. Kustin J, Rebar RW. Menstrual disorders in the adolescent age group. Prim Care1987;14:139-66.
3. Engle E, Shelesnyak M. First menstruation and subsequent menstrual cycles of pubertal girls. Hum Biol 1934; 6:431–453
4. Zhang K, Pollack S, Ghods A, Dicken C, Isaac B, Adel G, et al. Onset of ovulation after menarche in girls: a longitudinal study. J Clin Endocrinol Metab 2008;93:1186-94.
5. Treloar AE, Boynton RE, Behn BG, Brown BW. Variation of the human menstrual cycle through reproductive life. Int J Fertil 1967;12:77–126.
6. Vollman R. The menstrual cycle. Major Probl Obstet Gynecol 1977;7:1–193.
7. Metcalf MG, Skidmore DS, Lowry GF, Mackenzie JA. Incidence of ovulation in the years after the menarche. J Endocrinol 1983;97:213–19.
8. Foster C, Al-Zubeidi H. Menstrual Irregularities. Pediatr Ann 2018;47:e23-e 8.
9. American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics 2006;118:2245-50.
10. Jabbour HN, Kelly RW, Fraser HM, Critchley HO. Endocrine regulation of menstruation. Endocr Rev 2006;27:17-46.
11. Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. 2018 Aug 5. In: Feingold KR, Anawalt B, Boyce A et al, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
12. Critchley HOD, Maybin JA, Armstrong GM, Williams ARW. Physiology of the Endometrium and Regulation of Menstruation. Physiol Rev 2020;100:1149-79.
13. Messinis IE, Messini CI, Dafopoulos K. Novel aspects of the endocrinology of the menstrual cycle. Reprod Biomed Online 2014;28:714-22.
14. Maybin JA, Hirani N, Jabbour HN, Critchley HO. Novel roles for hypoxia and prostaglandin E2 in the regulation of IL-8 during endometrial repair. Am J Pathol 2011;178:1245-56.
15. Fraser IS. Regulating menstrual bleeding. A prime function of progesterone. J Reprod Med 1999;44 (2 Suppl):158-64.
16. Fleischer AC. Sonographic assessment of endometrial disorders. Semin Ultrasound CT MR 1999; 20:259–66.
17. Hall DA, Yoder IC. Ultrasound evaluation of the uterus. In: Callen PW, Ed. Ultrasonography in obstetrics and gynecology. 3rd ed. Philadelphia, Pa: Saunders, 1994; 586–614.
18. Treloar AE, Boynton RE, Behn BG, Brown BW. Variation of the human menstrual cycle through
reproductive life. Int J Fertil 1967;12 :77–126.
19. Vollman RF. The menstrual cycle. Major Probl Obstet Gynecol 1977;7:1–193.
20. World Health Organization Task Force on Adolescent Reproductive Health. World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. J Adolesc Health Care 1986;7:236–44.
21. Widhom O, Kantero RL. A statistical analysis of the menstrual patterns of 8,000 Finnish girls and their mothers. Acta Obstet Gynecol Scand 1971;14 (Suppl. 14):1–36.
22. Hallberg L, Högdahl AM, Nilsson L, Rybo G. Menstrual blood loss--a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynecol Scand 1966;45:320-51.
23. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med 2011;29:383-90.
24. Dasharathy SS, Mumford SL, Pollack AZ, Perkins NJ, Mattison DR, Wactawski-Wende J, et al. Menstrual bleeding patterns among regularly menstruating women. Am J Epidemiol 2012;175:536-45.
25. Schumacher U, Schumacher J, Mellinger U, Gerlinger C, Wienke A, Endrikat J. Estimation of menstrual blood loss volume based on menstrual diary and laboratory data. BMC Womens Health. 2012;12:24.
26. Wyatt KM, Dimmock PW, Walker TJ, O'Brien PM. Determination of total menstrual blood loss. Fertil Steril 2001;76:125–31.
27. Hallberg L, Nilsson L. Determination of Menstrual Blood Loss. Scand J Clin Lab Invest 1964;16:244–8.
28. Pendergrass PB, Scott JN, Ream LJ. A rapid, noninvasive method for evaluation of total menstrual loss. Gynecol Obstet Invest 1984;17:174-8.
29. Gudmundsdottir BR, Hjaltalin EF, Bragadottir G, Hauksson A, Geirsson RT, Onundarson PT. Quantification of menstrual flow by weighing protective pads in women with normal, decreased or increased menstruation. Acta Obstet Gynecol Scand 2009;88:275-9.
30. Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol 1990:97:734–9.
31. Janssen CA, Scholten PC, Heintz AP. A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Obstet Gynecol 1995;85:977–82.
32. Janssen CAH. A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Eur J Obstet Gynecol Reprod Biol 1996;70:21–22.
33. Fulwood R, Johnson CL, Bryner JD. Hematological and nutritional biochemistry reference data for persons 6 months-74 years of age: United States, 1976-80. Vital Health Stat 1982; 11:1-173.
34. Verlhac S, Morel M, Bernaudin F, Béchet S, Jung C, Vasile M. Liver iron overload assessment by MRI R2* relaxometry in highly transfused pediatric patients: an agreement and reproducibility study. Diagn Interv Imaging 2015;96:259–64.
35. Hekmatnia A, Radmard AR, Rahmani AA, Adibi A, Khademi H. Magnetic resonance imaging signal reduction may precede volume loss in the pituitary gland of transfusion-dependent beta-thalassemic patients. Acta Radiol 2010;51:71–7.
36. Di Maio S, Marzuillo P, Mariannis D, Christou S, Ellinides A, Christodoulides C, et al . A Retrospective Long-Term Study on Age at Menarche and Menstrual Characteristics in 85 Young Women with Transfusion-Dependent β-Thalassemia (TDT). Mediterr J Hematol Infect Dis 2021;13(1):e2021040.
37. Graff A, Christin-Maitre S. Insuficiencia ovárica prematura. EMC - Ginecología-Obstetricia 2019; 55:1-10.
38. Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women. Obstet Gynecol 2014;124:193-7.
39. Pederson J, Kumar RB, Adams Hillard PJ, Bachrach LK. Primary ovarian insufficiency in adolescents: a case series. Int J Pediatr Endocrinol 2015;2015:13.
40. Small CM, Manatunga AK, Klein M, Feigelson HS, Dominguez CE, McChesney R, et al. Menstrual cycle characteristics: associations with fertility and spontaneous abortion. Epidemiology 2006;17:52-60.
41. Zhang Q, Wang YY, Zhang Y, Zhang HG, Yang Y, He Y, et al. The influence of age at menarche, menstrual cycle length and bleeding duration on time to pregnancy: a large prospective cohort study among rural Chinese women. BJOG 2017;124:1654-62.
42. Gao Y, Hong X, Wang Z, Zhu Y. Endometrial receptivity and conception outcome among women with light menstrual bleeding of unidentified etiology. Int J Gynaecol Obstet 2018;140:37-41.
43. Wise LA, Mikkelsen EM, Rothman KJ,et al. A prospective cohort study of menstrual characteristics and time to pregnancy. Am J Epidemiol 2011;174:701-9.
44. Wesselink AK, Wise LA, Hatch EE, Rothman KJ, Mikkelsen EM, Stanford JB, et al. Menstrual cycle characteristics and fecundability in a North American preconception cohort. Ann Epidemiol 2016;26:482-7.
45. Popata VB, Prodanova T, Calisb KA, Nelson LM. The Menstrual Cycle A Biological Marker of General Health in Adolescents. Ann N Y Acad Sci 2008;1135: 43–51.
46 Harlow SD, Ephross SA. Epidemiology of menstruation and its relevance to women’s health. Epidemiol Rev 1995;17:265–86.
47. Rowland AS, Baird DD, Long S, et al. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiology 2002;13:668–74.
48. Jensen TK, Scheike T, Keiding N, et al. Fecundability in relation to body mass and menstrual cycle patterns. Epidemiology 1999;10:422–8.