title: Menstrual disorders and associated factors among adolescent girls visiting a youth clinic.
abstract: BACKGROUND
  Menstrual disturbances are common among teenagers and are often explained by immaturity of the hypothalamic-pituitary-gonadal axis. However, little is known about the underlying causes. The aim of this study was to evaluate endocrine mechanisms of menstrual disturbances and associated factors among adolescent girls visiting a Swedish youth clinic. METHODS. All adolescent girls visiting the youth clinic during a five-year period due to menstrual disturbances, except those with primary amenorrhea, were included in this retrospective study. These 203 girls were evaluated in a standardized manner by the same gynecologist. One third also met a psychologist and/or a dietician at the clinic.
  
  
  RESULTS
  Secondary amenorrhea was diagnosed in 117 girls (58%) and oligomenorrhea in 86 girls (42%). Menarcheal age was 13 in both groups. Hypothalamic inhibition of the gonadal axis was more frequent in the girls with secondary amenorrhea, whereas a hyperandrogenic hormonal pattern as a feature of polycystic ovary syndrome was more common in the oligomenorrheic girls. Different types of eating disorders were diagnosed in 68% of the amenorrheic girls and in 38% of the oligomenorrheic girls.
  
  
  CONCLUSIONS
  We found hypothalamic amenorrhea and hyperandrogenism to be frequent endocrine mechanisms of menstrual disorders in teenagers. Concomitant eating disorder was highly frequent and secondary amenorrhea was associated with anorectic behavior. It is important to evaluate endocrine patterns and eating behavior in adolescents with menstrual disturbances to ensure adequate medical care and treatment.
authors.affiliation: Department of Woman and Child Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden. marianne.wiksten@utbildning.stockholm.se
authors.forename: Marianne
authors.initials: M
authors.lastname: Wiksten-Almströmer
authors.forename: Angelica Lindén
authors.initials: AL
authors.lastname: Hirschberg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hagenfeldt
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000554:Ambulatory Care Facilities; D001068:Feeding and Eating Disorders / Q000150:complications; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications; D007986:Luteinizing Hormone / Q000097:blood; D008572:Menarche; D008599:Menstruation Disturbances / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013786:Thalamic Diseases / Q000150:complications
chemical_list: D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone