Pediatric and Adolescent Gynecology

In the past, a Pap test to screen for cervical cancer was advised for girls after they had been sexually active for 3 years, or at age 21, whichever came first. But the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society (ACS) now advise all women to have their first screening at age 21, no matter when they start having sex.

Gender words are used here to talk about anatomy and health risk. Please use this information in a way that works best for you and your doctor as you talk about your care.

Sexually active teens are at high risk for infection with the human papillomavirus (HPV). This is the virus that causes most cervical cancers, as well as other types of cancer. But research has shown that their bodies are able to get rid of the virus within 1 to 2 years. Teen girls may have precancerous sores on their cervix from HPV, but these usually go away on their own. 

Teen girls who delay their first Pap test until age 21 can avoid needing procedures to treat HPV precancers. Women between the ages of 21 and 29 should have a Pap test every 3 years, according to ACOG and ACS. Talk with a doctor about the schedule that is best for you.

Teens should get the HPV vaccine. This vaccine works well to protect people from the types of HPV that can cause cancer. The vaccine should be given before a teen becomes sexually active.

Amenorrhea in teens

What is amenorrhea in teens?

Amenorrhea is when a girl’s menstrual bleeding (period) doesn’t occur. There are 2 types:

• Primary amenorrhea. This type is when the first menstrual bleeding at puberty doesn’t occur by age 15. This problem may be lifelong.
• Secondary amenorrhea. This type is when normal menstrual bleeding stops occurring for 3 months or more. It may be because of a physical cause and usually happens later in life.

What causes amenorrhea in a teen?

Amenorrhea can have many causes, including:

• Ovulation problems. This can cause irregular or missed menstrual periods.
• Thyroid disorder. In many cases, a thyroid gland that is underactive or overactive can cause missed periods.
• Obesity. Girls who are overweight may have changes in ovulation due to body fat. This can cause missed periods.
• A lot of exercise. Some girl athletes don’t have menstrual periods because of low amounts of body fat.
• Eating disorder. Girls with anorexia or bulimia may have amenorrhea if their body weight is too low.
• Pituitary adenoma. This is a tumor that grows in the brain. It may cause problems with the normal function of hormones. This can prevent ovulation and cause missed periods.
• Physical problem (birth defect). If a girl has not started to menstruate by age 15, it may be from a problem with how the reproductive system formed before birth.
• Pregnancy. Menstrual periods stop during pregnancy.

Which teens are at risk for amenorrhea?

A teen is more at risk for amenorrhea for any of the below reasons:

• Being an athlete
• Being overweight
• Having an eating disorder
• Having a thyroid disorder
• Having ovulation problems

What are the symptoms of amenorrhea in a teen?

The main symptom is no menstrual bleeding when it’s expected.

The symptoms of amenorrhea can be like other health conditions. Make sure your teen sees her healthcare provider for a diagnosis.

How is amenorrhea diagnosed in a teen?

A healthcare provider diagnoses amenorrhea in these cases:

• No menstrual bleeding for 3 months or more in a girl with previously normal periods
• No menstrual bleeding for 6 months or more in a girl with irregular periods
• No menstrual bleeding by age 15

The healthcare provider will ask about your teen’s symptoms and health history. The provider will give your teen a physical exam. The physical exam may include a pelvic exam. Your teen may also have tests, such as:

• Blood tests. These look at hormone levels and check for pregnancy.
• Pelvic ultrasound. This painless test uses sound waves to create images of the inside of the body. It can show physical problems of the reproductive system.

The healthcare provider may also need to look for other menstrual disorders, health problems, or medicines that may be causing or making the condition worse.

How is amenorrhea treated in a teen?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on the cause and how severe the condition is.

Your teen may need to see a gynecologist. This healthcare provider treats the female reproductive system. Treatment for amenorrhea may include:

• Hormone treatment with progesterone
• Hormone treatment with birth control pills (oral contraceptives)
• Medicine to treat thyroid disorder
• Surgery for birth defects or other physical problems
• Changes in diet or exercise
• Treatment of an eating disorder
• Calcium supplements to reduce bone loss (osteoporosis)

Talk with your child’s healthcare provider about the risks, benefits, and possible side effects of all treatments.

What are possible complications of amenorrhea in a teen?

Possible complications include:

• Thinning bones. If amenorrhea is caused by low estrogen, this can also lead to thinning of bones (osteoporosis) over time. Your teen’s healthcare provider may advise her to take calcium supplements.
• Loss of fertility. If amenorrhea is caused by lack of ovulation, this means pregnancy may be difficult or not possible in the future.

What can I do to prevent amenorrhea in my teen?

Some preventable causes include eating habits and weight loss or weight gain. Talk with your child’s healthcare provider.

When should I call my teen’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better or get worse
• New symptoms

Key points about amenorrhea in teens

• Amenorrhea is when a girl’s menstrual bleeding (period) doesn’t occur.
• Primary amenorrhea is when the first menstrual bleeding at puberty doesn’t occur by age 15. Secondary amenorrhea is when normal menstrual bleeding stops occurring for 3 months or more.
• Amenorrhea has many causes, including hormone problems, eating habits and exercise, or a birth defect.
• Your teen may need blood tests and a pelvic ultrasound.
• Treatment may be done with hormones or other medicines, changes in diet or exercise, and calcium supplements.
• A girl with amenorrhea may have thinning bones (osteoporosis) over time and loss of fertility.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.