Adolescent Menstrual Issues

Girls typically begin their menstruation around 12 years old, but it can arrive any time between 10 to 15 years old. Menstrual cycles can be irregular for the first two to three years after the arrival of the first cycle. Cycles can be altered as the brain adjusts to influences like puberty, rapid weight gain or loss, stress and other factors like illness.

Normal menstrual cycles last from three to seven days and may occur every 21 to 35 days. Girls will typically change their tampon, sanitary pad or menstrual cup three to six times a day.

Every girl has their own schedule of when they first begin menstruation, the timing and intensity of the flow and the arrival of each cycle. The key to understanding a normal menstrual cycle is consistency and the amount of the blood flow. If cycles continue to be irregular after the third year of menstruation, or they impact well-being, a girl may seek treatment. These include:

• Heavy menses – Menstrual flow that requires a pad change every hour.
• Prolonged menses – Menses that last for more than seven days.
• Infrequent menses – Menses do not occur every month.
• Frequent menses – Menses that occur more than twice a month.
• Amenorrhea (absent) – This is the absence of a menstrual cycle for more than three months
  • Primary amenorrhea occurs when menstruation hasn’t begun by 15 years old
  • Secondary amenorrhea occurs when menses starts normally and then later becomes absent.

Signs of menstrual issues will range in severity and duration, depending on the type of condition. Symptoms can include:

Flow That’s Too Heavy Symptoms

• Anemia (low level of healthy red blood cells), leading to tiredness, fatigue (extreme tiredness) or shortness of breath
• Bleeding for longer than eight to 10 days
• Blood clots that are larger than the size of a quarter
• Repeatedly soaking through several feminine sanitary products per hour; requiring two products per use to control the flow
• Unable to perform daily activities due to heavy flow
• Waking up in the night to change sanitary pad, tampon or menstrual cup

Flow That’s Too Light Symptoms

• Continual, very light flow or just spotting throughout the cycle
• Bleeding often lasts for only one or two days each cycle
• More frequent, light menstrual cycles than typical flows during a 21- to 35-day cycle
• Only needing to change a sanitary pad, tampon or menstrual cup one or two times a day

Irregular Cycle Symptoms

• Cycles more frequently than every 21 days or infrequent periods such as skipping months
• Cycles are irregular for three years or more after periods start
• Extreme abdominal pain or cramping
• Excessive hair growth on the abdomen, chest or face
• If there are more than 45 days in between cycles
• If there is bleeding between cycles (spotting)
• Menstrual cycles that were regular, and then became irregular for over 3 months

Absence of Cycle Symptoms

The main symptom of amenorrhea is the absence of menstrual cycles. Other symptoms may be part of conditions that are causing the menstrual flow to stop.

The cause of menstrual issues can range and will depend on the type of condition. Causes can include:

Too Heavy Flow Causes

• Adenomyosis – Heavy bleeding can occur if the glands from the uterine lining become implanted in the uterine muscle. This is more common in adults and rare in adolescents.
• Genetic bleeding disorders – Some inherited (passed down through generations) disorders can cause abnormal bleeding. This includes Von Willebrand’s disease, which impairs the coagulation or blood clotting factor (the process where blood thickens from a liquid into a thick gel).
• Hormone imbalance – Typically, a balance of estrogen and progesterone hormones (primary female sex hormones) controls the growth of the endometrium (uterus) lining, which is shed during the monthly cycle. If the hormones are unbalanced, the uterus lining may grow too thick and is shed through a heavier flow. An imbalance can also occur due to polycystic ovary syndrome (PCOS), too high (hyperthyroidism) or too low thyroid levels (hypothyroidism), excess prolactin.
• Medications – Heavy or prolonged bleeding may be caused by anticoagulants like warfarin/Coumadin or enoxaparin/Lovenox.
• Other conditions – Heavy blood flow may be caused by some conditions like liver or kidney disease.
• Polyps – Heavy or prolonged bleeding may be caused by small, benign (non-cancerous) growths that form on the uterine lining. These are common in adults and rare in adolescents.
• Pregnancy complications – Heavy bleeding during a pregnancy may be due to a miscarriage, a low-lying placenta or placenta previa (the placenta covers the mother’s cervix, which is the lower end of the uterus).

Too Light Flow Causes

• Anxiety – Ongoing or short-bursts of stress can alter hormone balances, leading to light cycles.
• Birth control – An implant, patch, pill, ring or shot can make menstrual cycles lighter.
• Extreme exercise or dieting – Exercising too much can decrease the amount of flow during menstrual cycles. Rapid weight loss, eating disorders, not eating enough calories each day or being underweight can also have the same effect.

Irregular Flow Causes

• Anxiety – Ongoing or short-bursts of stress can alter hormone balances, leading to irregular cycles.
• Birth control – An implant, patch, pill, ring or shot can cause a skipped cycle.
• Extreme exercise or dieting – Exercising too much can change the timing or stop menstrual cycles. Rapid weight loss, eating disorders, not eating enough calories each day or being underweight can also have the same effect.
• Hormone imbalance – Irregular cycles may be the cause of a hormone imbalance like too much androgen (the hormone responsible for facial and chest hair growth).
• Other conditions – Diabetes, eating disorders, endometriosis and sexually transmitted infections can impact cycle frequency and/or amount.
• Polycystic ovary syndrome (PCOS) - With PCOS, Periods may be irregular, infrequent or absent.
• Thyroid disorder – Too high (hyperthyroidism) or too low thyroid levels (hypothyroidism) can cause irregular cycles.

Absent Flow Causes

• Anxiety – Ongoing or short-bursts of stress can alter hormone balances, leading to an absence of cycles.
• Birth control – An implant, patch, pill, ring or shot can make menstrual cycles stop.
• Birth defects, structural abnormalities or anatomical abnormalities – Changes in the typical structure of anatomy can cause menstrual cycles to cease. This can include vaginal obstructions that block blood from flowing from the uterus or cervix. This may also include abnormally developed reproductive organs, such as the absence of a cervix (end of the vagina), uterus (the womb) and/or vagina.
• Extreme exercise or dieting – Exercising too much can stop menstrual cycles. Rapid weight loss, eating disorders, not eating enough calories each day or being underweight can also have the same effect.
• Polycystic ovary syndrome (PCOS) – With PCOS, periods may be irregular or absent.
• Thyroid disorder – Too high (hyperthyroidism) or too low thyroid levels (hypothyroidism) can cause cycles to stop.
• Tumor – A tumor in the pituitary gland (responsible for hormone production) can affect menstruation.
• Uterine scarring – If scarring is present, the uterine lining may shed abnormally or stop developing altogether.