Adolescent Gynaecology

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The gynaecological problems in adolescence are different from that of adults and these conditions may be caused by other disease conditions or hormonal imbalance.

Delayed Puberty

Puberty changes usually occur between 7 and 13 years in girls and 9 and 15 years in boys. Delayed puberty is the condition where the child exhibits the puberty changes very late in life. Puberty changes observed in girls are development of breasts, sudden growth, onset of menstruation, growth of pubic hair. Delayed puberty occur because of familial history; medical conditions such as cystic fibrosis, kidney diseases, asthma, malnutrition and disorders of glands that produces hormones responsible for these changes.

Treatment depends on the cause for delayed puberty. Treatment options include treating underlying disease conditions or administration of hormonal preparations. In children with strong familial background and have no other causes, no treatment may be required.

Menstrual irregularities

Abnormalities in menstrual cycle of woman is called as menstrual irregularities. Various menstrual irregularities include:

  • Amenorrhea
    No menstrual periods until the age of 16 years or absence of menstrual periods for 3 consecutive months and is not pregnant
  • Dysmenorrhea
    Painful menstruation periods
  • Menorrhagia
    Excessive bleeding which lasts for 8 to 10 days
  • Oligomenorrhea
    Irregular menstrual periods or getting periods frequently
  • Premature ovarian failure
    Normal function of the ovary is stopped
  • Uterine fibroids
    Non-cancerous tumors observed in women of child bearing potential
  • Endometriosis
    In this condition, the tissues lining the uterus from inside grow outside the uterus (normally the tissue grows inside the uterus)

Symptoms observed in patients with menstrual irregularities include burning while urinating, fever, painful bowel movements, vaginal discharge, painful cramps, and lower back pain. Menstrual irregularities should be diagnosed early to prevent complications such as infertility (inability to get pregnant), anemia, hemorrhage, and uterine cancer. Treatment includes

  • For amenorrhea, medroxyprogesterone will be given
  • For dysmenorrhea, ibuprofen and naproxen are given to relieve pain
  • For menorrhagia iron supplements and anti-prostaglandin medications are given. In severe case of menorrhagia surgeries such as thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy will be done
  • For endometriosis, hormonal preparations, pain relievers will be given to shrink the tissues. Laparoscopic surgery is done to remove the tissues lining the uterus
  • Fibroids can be treated by medications that can slow or stop the growth of cancer and will relieve you from pain. Surgery can also be done to remove the fibroids

Ovarian cyst

Cysts are non-cancerous sacs filled with fluid that develop in women’s ovaries. Cysts are formed when the follicle that contains egg fails to break and release the egg out of the ovary, resulting in accumulation of fluid in the follicle.

Some of risk factors for cyst formation include heredity, early menstruation, irregular menstrual cycles, excessive upper body fat distribution, and hormonal imbalance. If there is more than one cyst present inside the ovary, the condition is called as polycystic ovary syndrome (PCOS).

Ovarian cysts usually do not cause any symptoms, but you must visit your doctor if you observe swelling or bloating of the abdomen, pain during bowel movements, pelvic pain, severe pain leading to nausea and vomiting, and pain in the pelvis region before or after the menstrual period begins.

Some cysts will disappear by themselves and some cysts that are large will require treatment. Treatment options include non-surgical and surgical treatment. The nonsurgical treatment includes

  • Birth control pills help to decrease formation of new cysts and prevent the formation of eggs that will become cysts
  • Nonsteroidal anti-inflammatory drugs such as ibuprofen and acetaminophen helps to relieve pain

Surgery will be recommended to remove the cyst or ovary if the medications do not help or cysts that are 5 to 10 cm in diameter. Different types of surgeries to remove the cysts include laparotomy and pelvic laparoscopy surgery.

Sexually transmitted infections (STIs)

They are infectious diseases caused by bacteria or virus that spread from one person to another by sexual contact. Adolescents who are sexually active may develop STIs because of lack of sex education and intense sexual experimentation.

The most common STI’s are chlamydia, genital herpes, AIDS, and gonorrhea. Some of the commonly occurring symptoms include vaginal discharge, pain in the lower abdomen, skin rash, ulcers, blisters around the genital area, and fever. If STIs are not treated it may lead to problems such as infertility, cancer of the cervix, paralysis, mental problems, heart damage, and also death.

Non-surgical treatment includes antibiotics such as penicillins, cefixime, tetracyclines, azithromycin, or erythromycin and antiviral medications such as acyclovir, famciclovir, and valacyclovir.

Mayer-Rokitansky-Kuster-Hauser syndrome

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a female disorder that mainly affects the reproductive system, causing the vagina and uterus to be underdeveloped or absent.

During early stage development in the womb, the reproductive system is formed. Girls with MRKH will start to grow the reproductive system but not fully develop. They will have normal ovaries and fallopian tubes with an absent or tiny uterus. The vaginal canal is typically shorter and may also be absent. In some cases, a kidney may also not have developed and they may suffer minor hearing loss or develop scoliosis.

The first sign of MRKH is the absence of menstruation by the age of 16, or primary amenorrhoea. Pelvic pain may also be present. MRKH has two forms, typical (Type A) and atypical (Type B). Type A is is characterized by congenital absence of the uterus and upper vagina with normal ovaries and fallopian tubes. Type B includes associated abnormalities of the ovaries and fallopian tubes and renal anomalies.

Girls will often have normal external genitalia and not know they have MRKH syndrome until their teens. The possibility of pregnancy will vary depending on your individual development.  If born with an incomplete vagina but normal sized uterus, they will be able to fall pregnant and carry a baby. If born with a tiny or absent uterus, they will not be able to become pregnant, however children can be possible with a gestational carrier.

Counselling plays a part in the treatment of MRKH syndrome as many young women are concerned that they aren’t a “real woman” once they learn they were born with an incomplete uterus and vagina. This is not the case, with blood tests able to confirm female genetics with 46XX chromosomes.

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