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.
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.