Menstrual disturbances in puberty.

The most significant corporal change observed in adolescent girls is the onset of menstruation, which occurs between 12 and 13 years of age. In several cases, described with the term 'precocious puberty', pubertal development can begin at a significantly younger age. The term 'delayed puberty' refers to absence of pubertal development in a girl over the age of 14. Amenorrhoea can occur due to a broad spectrum of causes, such as anatomic deficiencies of the reproductive tract and hormonal disorders. Hypogonadotrophic hypogonadism, which implies a permanent malfunction in gonadotrophin secretion; hypergonadotrophic hypogonadism, which involves poor ovarian response in gonadotrophin stimulation; and hyperprolactinaemia can also lead to amenorrhoea. Significant amount of stress on the adolescent girl can cause hypothalamic dysfunction, leading to a situation called 'hypothalamic amenorrhoea'. Abnormal uterine bleeding (AUB), and especially the subtype of dysfunctional uterine bleeding (DUB), is the most urgent gynaecological problem during adolescence, while dysmenorrhoea (also referred to as painful menstruation) is the most frequent problem for which adolescents and their parents refer to a physician. Copyright 2009 Elsevier Ltd. All rights reserved.