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Using the Menstrual Cycle as a Vital Sign: What We Still Want to Know about Adolescent Menstrual Cycles

      I remember the place and the conversation. Dr. Larry Nelson and I were attending an interdisciplinary women's health education retreat in Chantilly, Virginia, in 2000 and chatted over lunch.
      • Cain JM
      • Donoghue GD
      • Magrane DM
      • et al.
      Executive summary.
      Dr. Nelson was with the U.S. Public Health Service, working at the National Institute for Child Health and Disease, division of intramural research, and is known for his important work on defining and addressing primary ovarian insufficiency (POI).
      • Gordon CM
      • Kanaoka T
      • Nelson LM
      Update on primary ovarian insufficiency in adolescents.
      Our lunch conversation was wide ranging, but the conversation struck a chord when we started talking about the menstrual cycle. He mused that the menstrual cycle got no respect, which resonated with me, and we went on to talk about how the menstrual cycle should be considered a “vital sign,” like temperature, pulse, respiration, and blood pressure. Given my work with the American College of Obstetricians and Gynecologists Committee on Adolescent Health, I felt that this topic deserved a Committee Opinion and drafted a paper that was eventually published as the Committee Opinion “Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign,” which was also endorsed by the American Academy of Pediatrics.
      ACOG Committee Opinion No. 651: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
      ,
      American Academy of Pediatrics Committee on Adolescence and American College of Obstetricians and Gynecologists Committee on Adolescent Health Care: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
      This document made the case that the menstrual cycle should be considered a vital sign of overall health and that a diagnostic workup should be considered if menstrual cycle length is outside of a statistically derived normal range of 21-45 days on the basis of several large observational studies of menstrual cycle length in adolescence. I continue to believe that this construct is a useful one, as it allows us to pick up on a number of common pathologic conditions that otherwise can go undetected, including eating disorders and polycystic ovary syndrome (PCOS), but also uncommon conditions such as POI.
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      References

        • Cain JM
        • Donoghue GD
        • Magrane DM
        • et al.
        Executive summary.
        Am J Obstet Gynecol. 2002; 187: S4-S8
        • Gordon CM
        • Kanaoka T
        • Nelson LM
        Update on primary ovarian insufficiency in adolescents.
        Curr Opin Pediatr. 2015; 27: 511-519
      1. ACOG Committee Opinion No. 651: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
        Obstet Gynecol. 2015; 126: e143-e146
      2. American Academy of Pediatrics Committee on Adolescence and American College of Obstetricians and Gynecologists Committee on Adolescent Health Care: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
        Pediatrics. 2006; 118: 2245-2250
        • Magyar DM
        • et al.
        Regular menstrual cycles and premenstrual molimina as indicators of ovulation.
        Obstet Gynecol. 1979; 53: 411-414
        • Lucien JN
        • et al.
        The Launch of A Girl's First Period Study: demystifying reproductive hormone profiles in adolescent girls.
        J Pediatr Adoles Gynecol. 2022; 35: 420-425
        • Sun BZ
        • et al.
        Healthy post-menarchal adolescent girls demonstrate multi-level reproductive axis immaturity.
        J Clin Endocrinol Metab. 2019; 104: 613-623
        • Carlson LJ
        • Shaw ND
        Development of ovulatory menstrual cycles in adolescent girls.
        J Pediatr Adolesc Gynecol. 2019; 32: 249-253
        • Lucchetti MC
        • Tassi A
        First line therapy for vaginal atresia. conservative treatment vs surgical techniques: quandaries looking at numbers.
        J Pediatr Adolesc Gynecol. 2022; 35: 426-428
        • Baca M
        • et al.
        SAHM/NASPAG statement on leaked draft SCOTUS opinion regarding Mississippi v. Jackson Women's Health.
        J Pediatr Adolesc Gynecol. 2022; 35: 417-419
        • Grenvik JM
        • Keenahan L
        • Adeyemi-Fowode O
        Adnexal torsion due to borderline mucinous tumor of the gonad in a prepubertal girl with mixed gonadal dysgenesis (45,X/46,XY) and a Turner phenotype.
        J Pediatr Adolesc Gynecol. 2022; 35: 492-495
        • Dowlut-McElroy T
        • Gomez-Lobo V
        Gonadectomy in individuals with Turner syndrome and Y chromosome material: fertility considerations.
        J Pediatr Adolesc Gynecol. 2022; 35: 415-416
        • Dowlut-McElroy T
        • Shankar RK
        The care of adolescents and young adults with Turner syndrome: a pediatric and adolescent gynecology perspective.
        J Pediatr Adolesc Gynecol. 2022; 35: 429-434