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Most popular medical Questions
What constitutes excessive menstrual bleeding in an adolescent?As a rule, most menstrual periods do not last >8 days, do not occur more frequently than every 21-40 days, and are not associated with >80 mL of blood loss. The quantitation can be difficult because pad or tampon numbers correlate poorly with total blood loss. Blood clots or a change in pad numbers appears to have more reliability. Suspicion of excessive loss should prompt an evaluation of hematocrit and/or reticulocyte count.
How common are anovulatory menstrual periods in adolescents?
Anovulatory cycles (and with them, an increased likelihood of irregular periods) occur in 50% of adolescents for up to 2 years after menarche and in up to 20% after 5 years (the rate in adults). Anovulatory cycles result in unopposed estradiol production, which can cause the following: (1) breakthrough bleeding at varying intervals due to insufficient hormone to support a thickened endothelium, and (2) heavy and prolonged menstrual flow due to lack of progesterone. However, most anovulatory menstrual cycles are normal because the intact negative feedback loop (i.e., rising estradiol lowers FH and LSH, which, in turn, lower estradiol) does not allow for prolonged elevated estrogen with endometrial proliferation.
Why is dysmenorrhea more common in late rather than early adolescence?
Dysmenorrhea occurs almost entirely with ovulatory cycles. Menses shortly after the onset of menarche is usually anovulatory. With the establishment of more regular ovulatory cycles after 2-4 years, primary dysmenorrhea becomes more likely.
In a teenager with dysmenorrhea, what factors suggest an underlying identifiable pathologic problem rather than primary dysmenorrhea?
Primary dysmenorrhea is painful menses without identifiable pelvic pathology and accounts for the vast majority of cases in teenagers. However, underlying pathology is more likely if any of the following conditions are present: menorrhagia (excessive volume or duration of menses); intermenstrual bleeding; pain at times other than menses (suggesting outflow obstruction); or abnormal uterine shape on examination (suggesting uterine malformation).
How common is gynecomastia in teenage boys?
As many as 50-75% of boys between the ages of 12 and 14? 2 years have some breast development. In about 25%, it lasts for >1 year and, in 7%, for >2 years. It occurs most commonly during Tanner genital stages II and III, and it usually consists of subareolar enlargement (breast bud). It may be unilateral or bilateral. The breast bud may be tender, which indicates the recent rapid growth of tissue. Obese boys often have breast enlargement due to the deposition of adipose tissue, and differentiation from gynecomastia (true breast budding) is sometimes difficult.
Why does gynecomastia occur so commonly?
Early during puberty, the production of estrogen (a stimulator of ductal proliferation) increases relatively faster than does that of testosterone (an inhibitor of breast development). This slight imbalance causes the breast enlargement. In obese teenagers, the enzyme aromatase (found in higher concentrations in adipose tissue) converts testosterone to estrogen.
What drugs are associated with gynecomastia?
The drugs that cause this effect can be easier to recall using the CHEST acronym:
C
Calcium-channel blockers: verapamil, nifedipine
H
Hormonal medications: anabolic steroids, oral contraceptives
E
Experimental/illicit drugs: marijuana, heroin, amphetamines, methadone
S
pSychoactive drugs: phenothiazines, tricyclic antidepressants, diazepam
T
Testosterone antagonists: spironolactone, ranitidine, cimetidine, ketoconazole
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