Abstract
Study Objective
Understanding what constitutes a normal menstrual cycle during the first gynecological
year (GY1) is a common concern of adolescents and clinicians. However, limited high-quality
evidence exists. We aimed to summarize published literature regarding menstrual and
ovulatory patterns in GY1.
Design, Setting, Participants, Interventions, and Main Outcome Measures
Electronic databases (MEDLINE, Pre-MEDLINE, Embase, Web of Science, CINAHL, Cochrane
Library) were systematically searched from database inception to 2018. Eligible studies
described menstrual cycles, symptoms, or validated ovulatory data in healthy adolescents
in GY1. Two authors independently screened studies, extracted data, and assessed methodological
quality.
Results
Twenty-two studies involving more than 2000 adolescents were included. Thirteen recorded
menstrual cycle and/or symptom data and 14 measured ovulation. Mean cycle length ranged
from 32 to 61 days and decreased throughout GY1. Mean menses length was 4.9 to 5.4 days.
Frequent menstrual bleeding was reported in up to 23% of participants, infrequent
menstrual bleeding in up to one-third, and “irregular menstrual bleeding” in up to
43%. Dysmenorrhea was reported by 30%-89% of participants. Prevalence of ovulatory
cycles identified using luteal phase serum or salivary progesterone or urinary pregnanediol
was 0 to 45% and increased throughout GY1. However, all used definitions that would
be considered subovulatory in clinical practice.
Conclusion
Menstrual and ovulatory patterns in GY1 are diverse and differ from those of adults.
A transitional phase of menstrual and ovulatory immaturity is common. However, ovulation,
irregular cycles, and dysmenorrhea are not uncommon. As such, safe sexual practice
should be advocated and prompt medical management should be accessible.
Key Words
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Article info
Publication history
Published online: July 28, 2018
Footnotes
The authors indicate no conflicts of interest.
Preliminary study findings were presented in oral format at the following academic meetings:
1. Royal College of Paediatrics and Child Health Annual Conference, May 2017, Birmingham, United Kingdom.
2. Australasian Paediatric and Endocrine Group Annual Scientific meeting, August 2016, Alice Springs, Northern Territory, Australia.
Identification
Copyright
© 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
