¹Assistant Professor, ²Associate Professor, Department of Obstetrics and Gynecology, Government Medical College, Jammu, INDIA.

Email: parikhrana12345@gmail.com

RESULTS

During study period, total 396 adolescent girls visited gynaecology outpatient department were considered for present study. Most cases belonged to 17-19 years age (52.8 %) followed by 14-16 years age (37.4 %)

Table 1: Age distribution

In study cases, menstrual complaints (67.7 %) were most common indication to visit OPD, followed by complaints like irregular cycles (48.5 %), pain in abdomen (29.8 %), abnormal vaginal discharge (13.9 %), acne and hirsutism (13.6 %) and obesity (11.4 %). Other less common complaints were delayed puberty (4.5 %), Bartholin cyst/abscess (3.3 %), breast diseases (2.8 %), mass per abdomen (0.8 %) and urogenital malformations (0.8 %).

Table 2: Distribution Of complaints

On basis of history and relevant investigations, menstrual cycle related gynaecological problems such as dysmenorrhea (24.7 %), oligomenorrhoea (19.7 %), menorrhagia (16.9 %), metrorrhagia (14.9 %) and hypomenorrhea (11.4 %) were noted. Amenorrhea was noted in 9.8 % cases, 1.5 % had primary amenorrhea while 8.3 % cases had secondary amenorrhea. Other problems were anaemia (28.8 %), urinary tract infection (19.7 %), PID (12.4 %), teenage pregnancy (2.3 %) and ovarian cyst (1.0 %).

Table 3: Gynaecological problems observed

Secondary amenorrhoea (84.6 %) was most common among amenorrhea cases, most of them had polycystic ovarian disease (71.8 %) diagnosed as per Amsterdam’s criteria, others have hypothyroidism (28.2 %), hyperprolactinemia (12.8 %), hyperandrogenism (10.3 %), hyperglycemia/elevated fasting insulin (5.1 %), Among cases of primary amenorrhoea (15.4 %), 2 cases had Mullerian agenesis (5.1 %), 3 cases had hypogonadotrophic hypogonadism (7.7 %) and 1 case had testicular feminising syndrome (2.6 %),

Table 4: Etiology of amenorrhea

DISCUSSION

Gynaecological problems of adolescent girls is a different spectrum of gynaecological disorders, because of the nature of problems which are unique, special and specific for the age group. Gynaecological problems of this age group are associated with psychological factors which are very important in the growth and psychological development of any girl in the transition between childhood and womanhood. Childhood obesity, sedentary lifestyle, lack of exercises, and popularity of junk food in adolescence are responsible for the increasing PCOS incidence in adolescent girls and is challenge for gynaecologists treating them. Also, teenage pregnancy is also a frequent problem seen in girls from rural area. Teenage pregnancy associated with a significantly higher risk of pregnancy induced hypertension, eclampsia, premature onset of labour and increased neonatal morbidity and mortality.³ Anandhi A. et al.,⁴ studied awareness and different gynaecological problems in 500 adolescent girls attending gynaecology OPD. Menstrual complaints were the commonest indication for OPD consultation, 22% had dysmenorrhoea, 31% had DUB,13% had leucorrhoea as their primary symptom and 3.8% presented with primary amenorrhoea. Anaemia was the major health issue seen among 60% of the adolescents. Violent situations were seen in among 2.6% of adolescent families. 90% of the adolescents were aware of STD. 26% of married adolescents and 20% of adolescents who were not married were aware about the various methods of contraception. Hirani G⁵ studied 400 adolescent girls (10-19 years) presenting with gynaecological complaints presenting at gynaecology OPD, dysmenorrhea was the most prevalent complaint in the early adolescent group. Menstrual disorders were the most common presentation to the adolescent gynaecological outpatient department followed by abnormal vaginal discharge. Among menstrual disorders dysmenorrhea was the most common 42.5%, irregular menses 24.07%, and heavy menstrual bleeding 14.8%. Similar findings were noted in present study. Lalitha S⁶ noted that incidence of gynaecological problems was 6.25%. Different gynaecological problems were menstrual disorders ( 60% ), leucorrhoea ( 10.66% ), infections ( 8% ), ovarian cyst ( 5.33%), sexual assault (2.66% ), teenage pregnancy (10.66% ) and infertility ( 2.66% ). Majority of girls with menstrual disorders suffered from puberty menorrhagia (55.55%). Abnormal uterine bleeding was diagnosed in 74.28% of girls suffering from puberty menorrhagia. Pelvic inflammatory disease was exclusively seen in married adolescent girls (8 %). Vaginal atresia and imperforate hymen were causes of primary amenorrhoea (4.44 %). PCOD was the commonest cause of secondary amenorrhoea amongst adolescents (17.77 %). Similar findings were noted in present study. Anaemia is a primary contributor to maternal mortality and is associated with progressive physical deterioration of girls aged 10–19 years. Nutritional deprivation, increased demand of adolescents body, excessive menstrual blood loss all aggravate and exacerbate anaemia and its effects. Narasimhaiah A et al.,⁷ studied 351 adolescent girls attending the gynaecology OPD, teenage pregnancy (38.4 %) was the commonest indication for OPD consultation among adolescent girls followed by irregular cycle (17.9 %). Menorrhagia may be an important clinical manifestation in inherited bleeding disorders and needs to be evaluated especially for ITP, vWD, and factor VIII deficiency. Rathod AD et al.,⁸ studied 655 adolescent girls, menstrual complaints (84.88 %) were the commonest indication for OPD consultation. 17 girls required hospitalization; all of them needed blood transfusion due to significant severe anaemia resulting from puberty menorrhagia. 14 (82.35 %) had anovulatory DUB, while 2 (11.76 %) had coagulation disorders, and one (5.88 %) had hypothyroidism. Adolescent girls with menorrhagia need to be evaluated thoroughly earlier rather than later so that effective management can be started and severe anaemia with its consequences can be avoided. Government of India has already taken the initiative through ARSH (adolescent- friendly reproductive and sexual health services). It also includes counselling about common concerns and problems related to menstruation, balanced nutritious diet. Iron–folic acid supplementation to all adolescents is given, considering the need of iron with the onset of menstruation. In schools, adolescent girls should be screened for menstrual problems and health education regarding the menstrual problems and its management should be provided. It helps to prevent various gynaecological complaints that occur in their future life. Multi-pronged interventions are the need of the hour to raise awareness about the healthcare- seeking behaviour for gynaecological morbidities, especially in rural areas.⁹

CONCLUSION

In present study menstrual cycle related gynaecological problems (dysmenorrhea, oligomenorrhoea, menorrhagia, hypomenorrhea, amenorrhea), anaemia, urinary tract infection and PID were common in adolescent girls attending gynaecology OPD. Setting up a separate adolescent clinics is necessary for efficient management of menstrual disorders in adolescents, targeted health education and behavioural change.

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