Our daughter's periods result in time away from school.What can be done?

Teenagers are particularly reluctant to seek medical advice because of embarrassment. Frequently it is the mother who brings her daughter for advice particularly when school work is suffering.

There is a wide spectrum of normality in menstrual loss around puberty. The periods are rarely regular and consistent from the start. About 95% of girls will have their first period between the ages of eleven and fifteen.

The first period and those that immediately follow do not generally follow ovulation (egg release). The ovaries have started to produce oestrogens resulting in thickening of the lining of the uterus (endometrial lining); and a point is reached when the oestrogen levels are inade Quate to maintain this lining and a period occurs. When periods are excessive in amount or frequency, painful or infrequent, medical advice should be sought.  When the periods are too frequent, it may be difficult to determine whether each loss is a period or bleeding between periods (intermenstrual bleeding).

It is essential to take a full history. A general examination is usually conducted, but a pelvic examination can be withheld if this would cause embarrassment or discomfort. The management of heavy and irregular periods is discussed elsewhere (Chapter 24). Ultrasound examination of the pelvic organs will usually provide reassurance that the womb and ovaries appear normal. When periods are heavy from their outset, assessment of the blood clotting mechanism may be required.

The most common underlying bleeding disorder is von Willebrand disease, which occurs in only 1% to 2% of the general population but in approximately 13% of women with excessive menstrual bleeding.

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