Menstrual pattern and menstrual disorders among adolescents: an update of the Italian data

Italian Journal of Pediatrics

Egle Perissinotto⁹  Carlo De Sanctis⁴  Giorgio Tonini^1,10  Luciano Tatò⁶  Giorgio Radetti⁵  Fabio Buzi²  Mauro Bozzola^1,12  Gianni Bona¹  Luigi Bianchin⁷  Sergio Bernasconi^1,11  Vincenzo De Sanctis⁸  Franco Rigon³ 

[1] Division of Paediatrics, Department of Mother and Child Health, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy;Department of Paediatrics, "Carlo Poma" Hospital, Mantova, Italy;Department of Paediatrics, University of Padua, Padua, Italy;Paediatric Department of Paediatrics, Koelliker Hospital, Turin, Italy;Department of Paediatrics, Regional Hospital of Bolzano, Bolzano, Italy;Department of Paediatrics, University of Verona, Verona, Italy;Child and Adolescent Psychiatry Unit, ULSS 16, Padua, Italy;Private Accredited Hospital Quisisana, Paediatric and Adolescent Outpatients Clinic, Ferrara, Italy;Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy;Department of Paediatrics, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo" and University of Trieste, Trieste, Italy;Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy;Internal Medicine and Therapeutics, Section of Childhood and Adolescence, University of Pavia, Foundation IRCCS San Matteo, Pavia, Italy

关键词: Adolescents;    Dysmenorrhea;    Oligomenorrhea;    Polymenorrhea;    Bleeding length;    Menstrual cycle length;    Menstrual disorders;    Menstrual pattern;   

Others  :  825810
DOI  :  10.1186/1824-7288-38-38

 received in 2012-05-25, accepted in 2012-07-31,  发布年份 2012

【 摘 要 】

Background

The most striking event in the whole process of female puberty is the onset of menstruation. To our knowledge, no large population-based studies have been performed on the topic of menstrual health among Italian adolescents in recent years.

The aims of this study were to produce up-to-date information on the menstrual pattern of Italian girls attending secondary school, and to estimate the prevalence of menstrual cycle abnormalities in this population.

Methods

This was a cross-sectional study on a population-based sample of Italian adolescents aged 13–21 years attending secondary school. Only girls who had already started menstruating were requested to participate. Information was collected by means of a questionnaire that included items on the girls’ demographic details, anthropometrics, smoking and drinking habits, use of contraceptive pills, and socioeconomic status. The questions on the girls’ menstrual pattern concerned their age at menarche, duration of the most recent menstruation intervals (<21, 21–35, >35 days, variable), average days of bleeding (<4, 4–6, >6 days), and any menstrual problems and their frequency.

Results

A total of 6,924 questionnaires were administered and 4,992 (71%) were returned. One hundred girls failed to report their date of birth, so 4,892 subjects were analyzed. The girls’ mean age was 17.1 years (SD ±1.4); their mean age at menarche was 12.4 (±1.3) years, median 12.4 years (95%CI 12.3–12.5).

In our sample population, 3.0% (95%CI 2.5%-3.4%) of the girls had menstruation intervals of less than 21 days, while it was more than 35 days in 3.4% (95%CI 2.9%-3.9%). About 9% of the girls (95%CI 7.7%-9.4%) said the length of their menstruation interval was currently irregular. Short bleeding periods (<4 days) were reported in 3.2% of the sample population (95%CI 2.7%-3.7%), long periods (>6 days) in 19% (95%CI 17.9%-20.1%). Menstruation-related abdominal pain was reported by about 56% of our sample. About 6.2% of the girls (95%CI 5.4%-7.0%) were suffering from dysmenorrhea.

Conclusions

In conclusion, to the best of our knowledge, this is one of the largest studies on menstrual patterns and menstrual disorders among Italian adolescent girls. Adolescent girls referring persistent oligomenorrhoea, in first two years from menarche, had a higher risk for developing a persistent menstrual irregularity. They had longer bleeding periods (>6 days) and this has practical implications because it makes these adolescents potentially more susceptible to iron deficiency anemia. Clinicians need to identify menstrual abnormalities as early as possible in order to minimize their possible consequences and sequelae, and to promote proper health information.

We recommend that adolescents should be encouraged to chart their menstrual frequency and regularity prospectively from the menarche onwards.

【 授权许可】

   
2012 Rigon et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Tanner JM: Growth at adolescence. 2nd edition. Blackwell Scientific, Oxford; 1962.
• [2]Karapanou O, Papadimitriou A: Determinants of menarche. Reprod Biol Endocrinol 2010, 8:115. BioMed Central Full Text
• [3]Slap GB: Menstrual disorders in adolescence. Best Pract Res Clin Obstet Gynaecol 2003, 17(1):75-92.
• [4]Flug D, Largo RH, Prader A: Menstrual patterns in adolescent Swiss girls: a longitudinal study. Ann Hum Biol 1984, 11(6):495-508.
• [5]ACOG Committee on Adolescent Health Care: Menstruation in girls and adolescents using the menstrual cycle as a vital sign. Obstet Gynecol 2006, 108(5):1323-1328.
• [6]Fraser IS, Critchley HO, Munro MG, Broder M: Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod 2007, 22(3):635-643.
• [7]Singh A, Kiran D, Singh H, Nel B, Singh P, Tiwari P: Prevalence and severity of dysmenorrhea: a problem related to menstruation, among first and second year female medical students. Indian J Physiol Pharmacol 2008, 52(4):389-397.
• [8]Apter D, Viinikka L, Vihko R: Hormonal pattern of adolescent menstrual cycles. J Clin Endocrinol Metab 1978, 47(5):944-954.
• [9]Chan SS, Yiu KW, Yuen PM, Sahota DS, Chung TK: Menstrual problems and health-seeking behaviour in Hong Kong Chinese girls. Hong Kong Med J 2009, 15(1):18-23.
• [10]Treloar AE, Boynton RE, Behn BG, Brown BW: Variation of the human menstrual cycle through reproductive life. Int J Fertil 1967, 12(1 Pt 2):77-126.
• [11]Vollman RF: The menstrual cycle. Major Probl Obstet Gynecol 1977, 7:1-193.
• [12]Rigon F, Bianchin L, Bernasconi S, Bona G, Bozzola M, Buzi F, Cicognani A, De Sanctis C, De Sanctis V, Radetti G, Tatò L, Tonini G, Perissinotto E: Update on age at menarche in Italy: toward the leveling off of the secular trend. J Adolesc Health 2010, 46(3):238-244.
• [13]Hollingshead AB: Four factor index of social status. Yale University, New Haven, C; 1975. Unpublished manuscript
• [14]Petrozza J, Poley K: Dysfunctional uterine bleeding. In Glass's office gynecology. 5th edition. Edited by Curtis MG, Hopkins MP. Williams & Wilkins, Baltimore; 1999:241-264.
• [15]Speroff L, Glass RH, Kase NG: Dysfunctional uterine bleeding. In Clinical Gynecologic Endocrinology and Infertility. 5th edition. Williams & Wilkins, Baltimore; 1994:575-593.
• [16]World Health Organization: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. World Health Organization, Geneva, Switzerland; 1992.
• [17]World Health Organization: Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision. World Health Organization, Geneva, Switzerland; 1977.
• [18]Wyshak G, Frisch RE: Evidence for a secular trend in age of menarche. N Engl J Med 1982, 306(17):1033-1035.
• [19]Russo G, Brambilla P, Della Beffa F, Ferrario M, Pitea M, Mastropietro T, Marinello R, Picca M, Nizzoli G, Chiumello G: Early onset of puberty in young girls: an Italian cross-sectional study. J Endocrinol Invest 2011. Epub ahead of print
• [20]Metcalf MG, Skidmore DS, Lowry GF, Mackenzie JA: Incidence of ovulation in the years after the menarche. J Endocrinol 1983, 97(2):213-219.
• [21]World Health Organization (WHO): Multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World Health Organization Task Force on Adolescent Reproductive Health. J Adolesc Health 1986, 7(4):236-244.
• [22]Yen SSC: The human menstrual cycle: neuroendocrine regulation. In Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management. Edited by Yen SSC, Jaffe RB, Barbieri RL. W.B. Saunders Co., Philadelphia; 1999:191-217.
• [23]Wiksten-Almströmer M, Hirscheberg AL, Hagenfeldt K: Menstrual disorders and associated factors among adolescent girls visiting a youth clinic. Acta Obstet Gynecol Scand 2007, 86(1):65-72.
• [24]Asunción M, Calvo RM, San Millán JL, Sancho J, Avila S, Escobar-Morreale HF: A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000, 85(7):2434-2438.
• [25]Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R: Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998, 83(9):3078-3082.
• [26]Diamanti-Kandarakis E: Reproductive endocrinology: Infertility treatment in PCOS-is metformin in from the cold? Nat Rev Endocrinol 2012, 8(6):328-330.
• [27]Hoffman LK, Ehrmann DA: Cardiometabolic features of polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab 2008, 4(4):215-222.
• [28]Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN, PCOS/Troglitazone Study Group: Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006, 91(1):48-53.
• [29]Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004, 19(1):41-47.
• [30]Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF, Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society: The androgen excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009, 91(2):456-488.
• [31]Ersoy B, Balkan C, Gunay T, Egemen A: The factors affecting the relation between the menarcheal age of mother and daughter. Child Care Health Dev 2005, 31(3):303-308.
• [32]Papadimitriou A, Gousia E, Pitaouli E, Tapaki G, Philippidis P: Age at menarche in Greek girls. Ann Hum Biol 1999, 26(2):175-177.
• [33]Gallo PG: The age at menarche in some populations of the Veneto, North Italy. Ann Hum Biol 1977, 4(2):179-181.
• [34]Malina RM, Bouchard C, Shoup RF, Demirjian A, Lariviere G: Age at menarche, family size, and birth order in athletes at Montreal Olympic Games, 1976. Med Sci Sports 1979, 11(4):354-358.
• [35]Dewhurst CJ, Cowell CA, Barrie LC: The regularity of early menstrual cycles. J Obstet Gynaecol Br Commonw 1971, 78(12):1093-1095.
• [36]Widholm O, Kantero RL: A statistical analysis of the menstrual patterns of 8,000 Finnish girls and their mothers. Acta Obstet Gynecol Scand 1971, 14(Suppl 14):1-36.
• [37]Hickey M, Balen A: Menstrual disorders in adolescence: investigation and management. Hum Reprod Update 2003, 9(5):493-504.
• [38]Lee LK, Chen PC, Lee KK, Kaur J: Menstruation among adolescent girls in Malaysia: a cross-sectional school survey. Singapore Med J 2006, 47(10):869-874.
• [39]Benjamins LJ, Barratt MS: Evaluation and management of polycystic ovary syndrome. J Pediatr Health Care 2009, 23(5):337-343.
• [40]Jacot-Guillarmod M, Renteria SC: Menstrual disorders in adolescents: common place or worrisome? Rev Med Suisse 2010, 6:1236-1238. 1240–1
• [41]Popat VB, Prodanov T, Calis KA, Nelson LM: The menstrual cycle: a biological marker of general health in adolescents. Ann N Y Acad Sci 2008, 1135:43-51.
• [42]Beard JL: Iron requirements in adolescent females. J Nutr 2000, 130(2S Suppl):440S-442S.
• [43]Wintrobe MM, Lee GR: Wintrobe’s clinical hematology. 10th edition. Williams & Wilkins, Baltimore; 1999.
• [44]Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C: Laboratory diagnosis of iron-deficiency anemia: an overview. J Gen Intern Med 1992, 7(4):145-153.
• [45]Istituto Nazionale di Statistica: Indagine Multiscopo sulle Famiglie Aspetti della vita Quotidiana Anno 2003. ISTAT, Roma; 2005.
• [46]Pacifici R, Pichini S, Pizzi E, Zuccaro P: I giovani e il Fumo. Indagine Doxa, Osservatorio Fumo, Alcol e Droga, Istituto Superiore di Sanità; 2003. http://www.ossfad.is.it, 2003 webcite
• [47]Effective Health Care: Prevenzione dell’abitudine al fumo nei giovani. Edizione Italiana 2000, 4(3):1-12.
• [48]Donati S, Andreozzi S, Medda E, Grandolfo M: Salute riproduttiva:cosa pensano, quanto sono informati e come si comportano gli adolescenti. Riv Ital Med Adolesc 2004, 3(1):5-12.
• [49]Harris MF, Fanaian M, Jayasinghe UW, Passey M, Lyle D, McKenzie S, Davies GP: What predicts patient-reported GP management of smoking, nutrition, alcohol, physical activity and weight? Aust J Prim Health 2012, 18(2):123-128.
• [50]American Academy of Pediatrics Committee on Substance Abuse: Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention and management of substance abuse. Pediatrics 1998, 101(1 Pt 1):125-128.
• [51]American College of Obstetricians and Gynecologists Committee on Gynecologic Practice.ACOG Committee Opinion No. 483: Primary and preventive care: periodic assessments. Obstet Gynecol 2011, 117(4):1008-1015.