Gynecological Problems in Adolescence

1
Gynecological Problems in Adolescence

• Efthimios Deligeoroglou1, Aikaterini
  Deliveliotou1,
• Artemis Tsitsika2, George Creatsas1
• 1 Division of Pediatric-?dolescent Gynecology and
  Reconstructive Surgery, 2nd Dpt of Obstetrics and
  Gynecology, University of Athens Medical School,
  Athens, Greece
• 2 Center for Health and Prevention in
  Adolescence (CE.HE.P.A.) 1st Dpt of Pediatrics,
  Aghia Sophia Childrens Hospital, University of
  Athens, Greece

2
Introduction

• Gynecological problems of adolescence may affect
  adulthood fertility and health
• An adolescent with gynecological problems should
  be approached with sensitivity
• ? well-organized and effective management is of
  great importance and should be individualized

3
Objective

• To determine the most common gynecological
  problems in adolescence today
• To show our experience ?n the approach
• and management of this situation

4
Subjects and Methods

• Duration of study 09/ 2001 to 09/ 2004
• Number of visits 311 adolescents
• Mean age 15.9 (range 11-21 years)

5
Subjects and Methods

• Source of Referral
• Self-referred
  64.4
• Referred from pediatricians 19
• Referred from other doctors 17.6
• Aim of visit
• Consultation
  7.4
• Health problem 92.6

6
Subjects and Methods

• ?valuation process
• Detailed medical history
• Physical and gynecological examination
• Laboratory tests
• Other procedures depending on findings
• Management options
• Just counseling
• Pharmacotherapy and follow-up
• Referral to other specialists
• Hospitalization
• Surgery

7
Results

• PROBLEMS
  n
• Primary amenorrhea 43
  13.8
• Secondary amenorrhea 46
  14.8
• Other menstrual disorders 68
  21.8
• Dysfunctional uterine bleeding 28
  9
• Cervicitis or vaginitis
  26 8.3
• Ovarian mass
  25 8
• Breast problems 18
  5.8
• Hirsutism
  7 2.2
• Acne
  4 1.2
• Hirsutism Acne 5
  1.6
• Dysmenorrhea 5
  1.6
• Dysmorfia of external genitalia 8
  2.4

8
Primary amenorrhea

• defined as the condition of no menstruation by
  the age of 14 in absence of sexual maturation
  (Tanner stage 1) or by the age of 16, regardless
  of secondary sexual characteristics development.

9
Primary amenorrhea

• A thorough clinical examination and pelvic
  ultrasound were performed
• For those with normal uterus and vagina, an FSH
  level was crucial
• High FSH levels suggest ovarian failure /
• karyotype test warranted
• Low or normal FSH indicates hypogonadotropic
• hypogonadism or some form of delay/ pituitary
  tests (thyroid-stimulating hormone, growth
  hormone, cortisol, prolactin) and magnetic
  resonance imaging (?RI) were performed.

10
Primary amenorrhea

• 
  Patients
• 
  N
• MRKHS
  20 48
  
• Anorexia nervosa
  5 12
• ?menorrhea athletica
  2 5
• Hypergonadotrophic hypogonadism 4
  10
• with normal karyotype
• Hypogonadotropic hypogonadism 2
  5
• Elevated prolactin
  2 5
• Constitutional delay
  2 5
• No causative diagnosis 4
  10
• Total
  41 100
• ?ayer-Rokitansky-Kuster-Hauser syndrome
  (MRKHS)

11
Secondary amenorrheaOther menstrual disorders

• In the vast majority (80) of these cases
  polycystic ovarian syndrome (PCO) was diagnosed
• Manifestations irregular menses (amenorrhea or
  oligomenorrhea) and androgen excess
  (acne,hirsutism)
• An elevated LH serum level with normal or low FSH
  (elevated LH/FSH ratio, usually greater than 3)
  characterizes PCO
• Oral contraceptives were administered

12
Uterine Bleeding

• In all cases pregnancy and coagulopathies were
  excluded
• Anovulation was the main reason
• Combination oral contraceptives were administered
• One case was hospitalized (?b lt 7 gr/dl)

13
Vaginitis - Cervicitis

• Sterilized swabs were used and samples were taken
  from the vagina and/or cervix
• (in sexually active adolescents 6/26)
• Direct microscopy, cultures and PCR for
  chlamydia were applied
• ?ntibiotics were given, depending on the pathogen
• Pathogens
  n
• Candida albicans 5
• Anaerobes-Gardenella vaginalis 3
• Ureaplasma urealyticum 6
• Chlamydia trachomatis 3
• Trichomoniasis 1
• Physiological leukorrhea 3
• No isolation
  5

14
Ovarian masses

• Ultrasound and tumor markers (CA-125, HCG,
  a-FP,CEA) were indicated
• Functional cysts in 24 cases (follicular)
• Dysgerminoma in one case
• Spontaneous remission in 5/25 cases in 8 weeks
• Oral contraceptives in 15/25 cases
• Laparoscopic surgery in 5/25 of cases

15
Breast disorders

• ?symmetrical breast development 6
• Hypertrophy
  3
• Breast Abscess
  3
• Galactorrhea
  2
• Fibroadenoma
  1
• Cystic breast disease 2
• Mastodynia
  1

16
Acne and/or hirsutism

• Idiopathic hyperadrogenemia
• No association with menstrual disorders or other
  underlying pathology
• ?ral contraceptives (OC) were
• administered

17
DYSMENORRHEA

• Primary dysmenorrhea was diagnosed
• in all cases
• Prostagladin Synthetase Inhibitors
• (PSIs) were used
• Oral contraceptives were also
• administered in two cases,
• non responsive to PSIs

18
Dysmorfia of external genitalia

• Organic causes were excluded
• Surgical management was performed in
• these cases

19
Psychological Counselling

• Very essential
• Offered in all cases
• Especially critical in cases of abnormal genital
  tract or infertility
• Alternatives to childbearing were discussed in
  late adolescence or at any time the patient
  specifically asked

20
Conclusions

• There is a growing concern about gynecological
  problems in adolescents as they may affect
  reproductive competance
• Referral of adolescents from pediatricians and
  other doctors in adolescent well-organized
  clinics is of great importance
• Multidisciplinary and individualized management
  is considered necessary