ACOG Recommends Menstrual Management for Teens

Holy Hormones Journal: Yes, I agree – menstruation is a vital sign of teen health – however, what I am wary of is menstrual management at an early age for girls who may not need alice_through_the_looking_glassthat type of medical intervention. And being the well-informed skeptic that I am – I also see this as a ploy to get young girls into the doctor’s office at an early age – with an alarming trend on lack of parental consent by the time your daughter is 11 or 12 – (as in California where parental rights over certain aspects of health care have been relinquished). And before you know it they are on a synthetic contraceptive like an IUD, implant or injection. And the next step is – yes the HPV vaccine – all without your consent.

In 2006 – I posted another article from Medscape News about evaluating the menstrual cycle with a girl’s development and her mental health. (Yikes have been blogging for a decade of more – did not have much to say back then – but I sure do now.)

Evaluation of the menstrual cycle is a viable tool to assess healthy development of teen girls’ menstrual patterns, according to new guidelines published by the American Academy of Pediatrics (AAP) in the November issue of Pediatrics. ~ AAP Issues Guidelines for Menstrual Cycle Evaluation

That recommendation really did not make mainstream – let alone into clinical offices. And the trend is still to put young women on LARC’s (long-acting reversible contraception) at the onset of menstruation. May I remind you – there are no long term studies on the use of contraceptives for this age group – nor any age group of women for that matter.

I am going to be putting my comments/insights in blue – next to the menstrual cycle characteristics bullets below.

Beware of the wolf in sheep’s clothing… if your daughter exhibits any of the signs below – seek out an integrative functional endocrinologist – someone who understands and is trained in hormones and hormonolgy – versus GP’s or gynecologists who do not have this training – and who are many times all to quick to prescribe medication and birth control. Oh yes, they might also throw in some anti-depressants for good measure.

Menarche is the most fragile time of a young girl’s life. Menstrual management – instead of healing the imbalance will lead her down the rabbit hole of continued health management – a cash cow for everyone involved – except for you – the parent – and of course your daughter who will be left with feelings of inadequacy and shame throughout her life.

I do concur with the last statement (but again beware the sheep clothes) that young girls should be taught how to chart – with an app. And parent’s should also keep their own charts that reflect her moods, and behaviors during her month-long cycle. At some point in time that will be a conversation to have (not when she is hormonal and premenstrual).  If young women understand their fluctuating hormones at an early age – they will build a foundation of strength, trust and empowerment.

The take-away – chances are your daughter is not going to fall into the “normal range” – do not be swayed and lose your daughter to menstrual management at an early age. Mothers and even father’s are the ones who should be discussing menstruation with their daughters – not the doctor.

Include Menstrual Cycle as a Vital Sign for Teens, ACOG Says

Medscape Medical News
Ricki Lewis, PhD
November 25, 2015


Including evaluation of the menstrual cycle as a vital sign can alert healthcare providers to disorders that cause abnormal uterine bleeding in adulthood, according to a committee opinion from the American College of Obstetricians and Gynecologists, published online and in the December issue of Obstetrics & Gynecology.

“Just as abnormal blood pressure, heart rate, or respiratory rate may be key to diagnosing potentially serious health conditions, identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood,” the opinion states.

Median age at menarche is typically between the 12th and 13th year (median, 12.43 years) in nations with adequate nutrition. Irregular cycles are common in early adolescence, with a longer time between the first and second cycles than happens later. Within 3 years, 60% to 80% of menstrual cycles are between 21 and 34 days long, as is the average among adults.

When cycles do not even out, it may be a sign of problems, but adolescents may lack information on menstruation, be uneasy asking for it, and not have the experience to recognize an atypical pattern of menses. Therefore, clinicians need to ask about menstruation patterns and educate patients and their parents or caregivers about what is the normal range of duration of menses and amount of bleeding, the committee notes.

Among patients whose cycles do not fall within the normal range, the committee recommends physicians first rule out pregnancy, sexually transmitted infections, and sexual trauma, and then extend clinical evaluation to exclude the following causes of abnormal uterine bleeding: coagulopathy, thyroid disease, immaturity of the hypothalamic–pituitary–ovarian axis, hyperprolactinemia, hyperandrogenic anovulation (including polycystic ovary syndrome, congenital adrenal hyperplasia, and androgen-producing tumors), hypothalamic dysfunction (including eating disorders and response to stress), primary pituitary disease, primary ovarian insufficiency, response to a medication, iatrogenic causes such as radiation or chemotherapy, and malignancy (rhabdomyosarcoma, androgen-producing tumors, and estrogen-producing ovarian tumors).

The opinion lists menstrual cycle characteristics that require evaluation:

  • Onset: Reaching age 15 years without menarche. The first period begins by age 15 years for 98% of patients, which is within 3 years of menarche. The age of concern is 14 years for girls with hirsutism or who have a history or presence of an eating disorder or of excessive exercise.
    • Girls may not be menstruating from many reasons at age 15. They are faced with hormone imbalance – and in many cases an excess of estrogen and very low levels of progesterone. If girls have hirsutism – it may also be due to the HPV vaccine Gardasil – a severe endocrine disruptor – causing male-like hair growth in women of all ages who have received the vaccine. Polycystic ovarian disorder is another side effect of the HPV vaccine – as well as a sign of hormone imbalance. Yes, eating disorders will affect menstruation – as well as excessive exercise. It is important that girls are taught to live with the changing phases of the menstrual cycles at an early age. Eating disorders are a cause of concern – however, psych meds are not the answer for that imbalance either.
  • Frequency of menses: Menses that takes place more frequently than every 21 days or less frequently than every 45 days, or a gap of 90 days between periods, even for one cycle. Mean cycle interval is 32.2 days for the first year.
    • Well, my head is spinning on this one – but what this comes down to are irregular cycles – and for the most part – this is to be expected at this age. Do not be fooled by the doctor who says – s/he wants to manage menstruation with birth control. There is no such thing. Birth control will suppress your daughter’s menstrual/endocrine rhythm with almost guaranteed health consequences for her in the future. 
  • Duration: Menses lasts more than 7 days.
    • Menses lasting more than 7 days is called hemorrhaging and unfortunately, this is happening to women of all ages. What this means is that the uterine capillaries (tiny blood vessels) have become weakened – either due to a nutrient deficiency (bioflavonoids – which is a essential micronutrient to strengthen all blood vessels, capillaries and veins in the body – and or/low levels of progesterone – which is necessary to maintain the uterine lining. This hormone also prevents miscarriage.
  • Excessive bleeding: Soaking more than one pad or tampon every 1 to 2 hours, history of easy and excessive bruising or bleeding, or a family history of a bleeding disorder.
    • See above.

The committee recommends that discussions of menstruation begin at the 7- or 8-year visit. Once menstruation has started, clinicians should ask a girl/adolescent patient at every visit the first day of the last menstrual period and her pattern of menstruating. Patients should be encouraged to chart their cycles, perhaps using smart phone apps.

Read full article…



Author: Leslie Carol Botha

Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.