Paediatric and adolescent gynaecology

Please send referral letters to uclh.pag.referrals@nhs.net

Advice on management of adolescent menstrual dysfunction ahead of clinic review
Currently our waiting time for clinic is over 6 months. Therefore, please consider the treatment suggestions below with your patient and their parent/care-giver ahead (This treatment advice is based on guidance from the British Society of Paediatric and Adolescent gynaecology)

Heavy periods:

Please consider need for bloods: eg. FBC & ferritin (and please forward these results uclh.pag.referrals@nhs.net)

• Tranexamic acid 1g three times a day
• NSAID eg. Mefenamic acid 500mg three times a day

Irregular / prolonged bleeds:

Irregular periods are expected in the first year of menarche.

If irregular cycles persist, consider arrange hormone profile before initiating hormonal options.

FSH LH Estradiol Prolactin TFT Testosterone SHBG - please forward these results

USS assessment for polycystic ovaries is not recommended within 8 years of menarche as part of PCOS work up in adolescents.

Hormonal options to consider for irregular periods:

• Cyclical progesterones (not contraceptive)
  Norethisterone 5mg three times a day on a cyclical regime of 21 days with 7 days (21/7) break can be used for 3-6 months before stopping to see if cycle has improved
  Alternatively if venous thromoboembolic risk factors can trial Medroxyprogesterone 10mg BD on a cyclical regime

• Combined Oral Contraceptive Pill (Typically avoid for first 12 months from menarche unless contraception needed)
  First line COCP: 30mcg ethynylestradiol with levonorgestrel 50mcg to regulate cycle using a 21/7 regime
  (20mcg EE2 containing COCP are more associated with irregular / breakthrough bleeding)
• Desogestrel 75mcg continuously
  Less recommended if young person wants regular bleeds as unpredictable bleeding pattern
  (5/10 users will have amenorrhea or light infrequent bleeds, 4/10 will have regular bleeding and 1/10 will have frequent bleeding).

Painful periods:

• NSAID eg. Mefenamic acid 500mg three times a day

Hormonal options to consider:

• Desogestrel 75mcg once daily continuously
• COCP 21/7 regimen or tricycle
• Cyclical progesterones