Page 63 - PCC07

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Irregular menstrual cycles and ovulatory dysfunction
• Adolescent:
– Cycle interval variation by gynaecological age
– Anovulation common physiological occurrence
– Avoid over diagnosis AND avoid missed diagnosis
• Identify adolescents at risk
• Reassess where “at risk”
– Controversy around how to define normal and abnormal cycles
– 95th centile cut offs from the general population • Specificity
• Not based on physiology
– Cluster analysis and long term outcomes needed
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Recommendations for defining Irregular Cycles
Irregular cycles and ovulatory dysfunction
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Irregular menstrual cycles are defined as:
‐ normal in the first year post menarche as part of the pubertal transition ‐>1to<3yearspostmenarche: <21or>45days
‐ > 3 years post menarche to perimenopause:
< 21 or > 35 days or < 8 cycles per year
‐ > 1 year post menarche > 90 days for any one cycle
‐ Primary amenorrhea by age 15 or > 3 years post thelarche
When irregular menstrual cycles are present a diagnosis of PCOS should be considered and assessed according to the guidelines.
****
_
CR
In an adolescent with irregular menstrual cycles, the value and optimal timing of assessment and diagnosis of PCOS should be discussed with the patient, taking into account diagnostic challenges at this life stage and psychosocial and cultural factors.
****
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CPP
When commencing hormonal contraception in adolescents, where PCOS features are noted, an “increased risk” of PCOS can be considered and reassessment advised
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PRECONGRESS COURSE 07 I BARCELONA, SPAIN – 1 JULY 2018 63