Oya ERCAN, Olcay EVLİYAOĞLU, Müjgan ALİKAŞİFOĞLU

Ergenlerde menstrüel döngü bozuklukları

Ergenlerde normal menstrüel döngünün gelişebilmesi için genel vücut sağlığının iyi olması yanında hipotalamus-hipofiz-gonad ekseninin düzgün çalışması gereklidir. Bu nedenle birçok bozukluk birincil-ikincil amenoreye veya menstrüel düzensizliklere neden olabilir. Menarştan sonraki ilk iki yıl genellikle anovulatuvardır. Buna bağlı olarak menstrüel hayatın ilk yıllarında normal ergenlerde döngü düzensizlikleri, az veya çok menstrüel kanamalar görülebilir. Bu derlemede normal menstrüel döngünün fizyolojisi, menstrüel bozukluklar, tanı ve tedavi yaklaşımları tartışılmaktadır.

Menstrual cycle disorders in adolescence

In adolescence, for the initiation of normal menstrual cycle hypothalamo-pituitary-ovarian axis should be intact in addition to good general health, different disorders can cause primary-secondary amenorrhea or menstrual irregularities. The first two years after menarche is generally anovulatory thus in normal adolescents in the first years of menstrual life irregularities in menstrual cycle and menstrual blood flow can be observed. Physiology of normal menstrual cycle, menstrual disorders, their diagnosis and treatment are discussed in this review.

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1. Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics 2006; 118 :2245-50.
2. Golden NH, Carlson JL. The pathophysiology of amenorrhea in the adolescent. Ann N Y Acad Sci 2008; 1135: 163-78.
3. American Academy of Pediatrics American College of Obstetricians and Gynecologists. Mensturation in girls and adolescents: using the menstruel cycle as a vital sign. Pediatrics 2006; 118: 2245-50.
4. Semiz S, Kurt F, Kurt DT, Zencir M, Sevinc O. Pubertal development of Turkish children. J Pediatr Endocrinol Metab 2008; 21: 951-61.
5. Ekerbicer HC, Celik M, Kiran H, Kiran G. Age at menarche in Turkish adolescents in Kahramanmaras, Eastern Mediterranean region of Turkey. Eur J Contracept Reprod Health Care 2007; 12: 289-93.
6. Neyzi O, Alp H, Orhon A. Sexual maturation in Turkish girls. Ann Hum Biol 1975; 2: 49-9.
7. World health organization task force on adolescent reproductive health. World health organization multicenter study on menstruel and ovulatory patterns in adolescent girls. II. longitudinal study of menstruel patterns in the early postmenacheal period, duration of bleeding episodes and menstruel cycles. J Adolesc Heath Care 1986; 7: 236-44.
8. Venturoli S, Porcu E, Fabbri R, et al. Longitudinal evaluation of the different gonadotropin pulsatile patterns in anovulatory cycles of young girls. J Clin Endocrinol Metab 1992; 74: 836-41.
9. Apter D, Vihko R. Early menarche, a risk factor for breast cancer, indicates early onset of ovulatory cycles. J Clin Endocrinol Metab 1983; 57: 82-6.
10. Vihko R, Apter D. Endocrine characteristics of adolescent menstrual cycles: impact of early menarche. J Steroid Biochem 1984; 20: 231-6.
11. Flug D, Largo RH, Prader A. Menstrual patterns in adolescent Swiss girls: a longitudinal study. Ann Hum Biol 1984; 11: 495-508.
12. Fleischman A, Gordon C. Adolescent menstruel abnormalities. In: Lifshitz F (ed). Pediatric Endocrinology. New York: Informa Healthcare USA, Inc; 2007: 349-63.
13. Claessens EA, Cowell CA. Acute adolescent menorrhagia. Am J Obstet Gynecol 1981; 139: 277-80.
14. Bevan JA, Maloney KW, Hillery CA, Gill JC, Montgomery RR, Scott JP. Bleeding disorders: A common cause of menorrhagia in adolescents. J Pediatr 2001; 138: 856-61.
15. Ellis MH, Beyth Y. Abnormal vaginal bleeding in adolescence as the presenting symptom of a bleeding diathesis. J Pediatr Adolesc Gynecol 1999; 12: 127-31.
16. Goodman LR, Warren MP. The female athlete and menstrual function. Curr Opin Obstet Gynecol 2005; 17: 466-70.
17. Gidwani GP. Amenorrhea in the athlete. Adolesc Med 1999; 10: 275-90.
18. American Academy of Pediatrics. Committee on sports medicine and fitness. Medical concerns in the female athlete. Pediatrics 2000; 106: 610-3.
19. Laughlin GA, Yen SS. Hypoleptinemia in women athletes: absence of a diurnal rhythm with amenorrhea. J Clin Endocrinol Metab 1997; 82: 318-21.
20. Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycyctic ovary syndrome. Fertil Steril 2004; 81: 19-25.
21. Betterle C, Rossi A, Dalla Pria S, et al. Premature ovarian failure: autoimmunity and natural history. Clin Endocrinol (Oxf) 1993; 39: 35-43.
22. Rosenfield M, Cooke D, Radovick S. Puberty and its disorders in female. In: Sperling M (ed). Pediatric Endocrinology. Philadelphia: Saunders Elsevier, 2008: 530-609.
23. Mortola JF. Premenstrual syndrome-pathophysiologic considerations. N Engl J Med 1998; 338: 256-7.
24. Johnson SR. Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners. Obstet Gynecol 2004; 104: 845-59.
25. Dattani MH, Hindmarsh PC. Normal and abnormal puberty. In: Brook C, Clayton P, Brown R (eds). Book's Clinical Pediatric Endocrinology. Fifth ed. Massachusetts: Blackwell Publishing Ltd, 2005: 183-210.
26. Baysal B. Polikistik over sendromu ve hirsutizm. In: Ercan O, Alikaşifoğlu M (yazarlar). Adolesan Sağlığı. İstanbul: İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri, 2008: 99-107.
27. Matytsina LA, Zoloto EV, Sinenko LV, Greydanus DE. Dysfunctional uterine bleeding in adolescents: concepts of pathophysiology and management. Primary Care Clin Office Pract 2006; 33: 503-15.
28. Bravender T, Emans SJ. Menstrual disorders. Dysfunctional uterine bleeding. Pediatr Clin North Am 1999; 46: 545-53.
29. Rosenfield RL, Barnes RB. Menstrual disorders in adolescence. Endocrinol Metab Clin North Am 1993; 22: 491-505.
30. Dimmock PW, Wyatt KM, Jones PW, O'Brien PM. Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. Lancet 2000; 356: 1131-6. 31.
31. Muse KN, Cetel NS, Futterman LA, Yen SC. The premenstrual syndrome. Effects of "medical ovariectomy". N Engl J Med 1984; 311: 1345-9.