“Adolescent girl” THEY ARE DIFFERENT

A  Anemia, Abortion, Abuse
D  Developing, Depressed
O  Obese, Overindulging
L  Lack of information
E  Experimenting
S  Social, Sexual,
C  Courageous
E  Emotional
N  Never say no to peers
T  Temperamental, Teenage pregnancy

Gynaecologist require

• Specific knowledge & expertise
• •No treatment is also an option
• Gynaecological problems are common
• Serious pathology is rare
• S/T congenital disorders present 1st time
• Vaginal examination only if sexually active or very necessary

MENSTRUAL DYSFUNCTION

• Common – immature HPO axis for 2 years
• May disguise other worries- contraception, bullying, abuse, STD, pregnancy
• Privacy during counceling

MENORRHAGIA (Heavy Period )Clots, prolonged days

• •Menstrual diary, 3-7/21-45, explanation, reassurance is required.
• Anti-Fibrinolytics – Tranexamic acid.
• Anti-Prostaglandin- Mefenamic acid.
• Cyclic Progesteron for 21days.
• COC

Intractable Menorrhagia (Very Heavy Period)

• 10-20% bleeding disorders.
• USG, coagulation profile, EUA, Hysteroscopy.
• Admission & Blood transfusions.
• High doses of Estrogen, Factor Vll a
• DMPA, MIRENA ( mentally retarted)
  

 DYSMENORRHOEA (Painful period)

• Mild - Anti-Prostaglandin / COC
• Refractory - USG, MRI, Laparoscopy to rule out
  Obstruction of lower genital tract
  Endometriosis

ENDOMETRIOMA-USG

50% of adolescent girls with severe gysmenorrhea opelvic pain are found to have endometriosis

ENDOMETRIOMA

Bilateral endometriosis cyst Seen at laparoscopy “Reccurrence High”

DISORDERS OF PUBERTY

PRECOCIOUS PUBERTY

• Precocious puberty- <8yrs age
• Idiopathic 75%- treatment by GnRh agonist
• Others- Hypothalamic lesion
          Functioning gonadal tumor
          Exogenous Estrogen
          McCune-Albright syndrome

DELAYED PUBERTY

• >14 years- No secondary sex character
• Causes- Idiopathic, Chronic medical illness, Gonadal failure,
  Gonadotropin deficiency, Anatomical anomalies
• Estrogen- for breast development & bone protection
  

AMENORRHOEA(No Periods)

• Primary
  -14yrs - without sec. sex characters
  -16yrs - With sec. sex characters
• Secondary
  - no menses >6mths

AMENORRHOEA(Causes)

• Pregnancy
• Uterus / Vagina- Obstruction, Adhesions, Agenesis
• Ovarian- PCOD, Premature ovarian failure, Agenesis, Iatrogenic
  

AMENORRHOEA (No Periods)(Diagnosis)

• Hypothalamic- Excessive exercise, Idiopathic, Head injury
• Pituitary- hyper. / hypopituitarism, hyperprolactinemia
  

IMPERFORATED HYMEN

One of the causes of No periods

AMENORRHOEA

• BMI, Pubertal staging, Hirsutism, Signs of Turners syndrome
• Investigations- pregnancy test, FSH/LH/PRL, TFT, Androgen levels, SHBG, Karyotyping
• Imaging- USG, MRI, BMD
• Treatment is according to cause

OVARIAN MASS

• Rare- 6% of all Ovarian Tumors
• 36%- Physiological
• 64%- Neoplastic
               Benign- Epithelial cell & Teratoma
               Malignant- Germ cell 58%
                                Epithelial cell 19%
                                Stromal cell 18%
• Early diagnosis of torsion-to save the ovary
  

PRACTICE POINT

• Gynecological symptoms can mask other pressures eg bullying or abus
• Endometriosis is a common cause of severe dysmenorrhoea