ACOG: The menstrual cycle is a vital sign

A December 2015 American College of Obstetricians and Gynecologists (ACOG) Committee Opinion recommends that menstrual history be used as a vital sign when evaluating the health of girls and adolescents.

Noting that “identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood,” and because changes in the menstrual cycle may serve as indications of so many conditions, ACOG recommends that clinicians “have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient.” The Opinion states, “by including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers.”

The Opinion notes that a number of medical conditions can cause abnormal uterine bleeding in adolescents. These include:

• Immaturity of the hypothalamic-pituitary-ovarian axis

• Hyperandrogenic anovulation

• Coagulopathy

• Hypothalamic dysfunction

• Hyperprolactinemia

• Thyroid disease

• Primary pituitary disease

• Primary ovarian insufficiency

• Iatrogenic (eg, secondary to radiation or chemotherapy)

• Medications (eg, hormonal contraception or anticoagulation therapy)

• Sexually transmitted infections

• Malignancy (eg, estrogen-producing ovarian tumors, androgen-producing tumors, or rhabdomyosarcoma)

• Uterine lesions

The Opinion, which was produced by ACOG’s Committee on Adolescent Health Care, also notes that adolescent girls may be unaware that their menstrual bleeding patterns are abnormal or may signify underlying disease.