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Adolescent Clinic

Adolescence (10 to19 years) is a tumultuous phase when a girl blossoms into a woman, a time of emotional, physical, psychological and social change. Hormones rage, body changes, girls are confused and find it hard to relate to their new self. It also makes them curious and excited about the opposite sex. Added to this, being bombarded by a world of misinformation makes them even more vulnerable. All of these uncertainties push them toward wrong lifestyles and unnecessary complexes, which could have long term consequences on their physical and mental health.

So, it is vital that their concerns are addressed lovingly and empathetically from a sound scientific base.

 

Adolescents can face a broad range of gynaecological and other concerns, some of the common ones are listed below.

 

MENSTRUAL ISSUES

 

Excessive Menstrual Flow- menstrual flow is considered excessive when it is prolonged for more than 7 days or warrants change of pads very often (around 2 hours), causing anaemia, disrupting school, work and social activities. Menstrual cycles are initially(first 1-2 years), anovulatory resulting in irregular and excessive periods due to immaturity of the hypothalamic-pituitary-ovary axis.

 

Painful periods/Dysmenorrhoea- Dysmenorrhea, or menstrual cramps, is a common menstrual problem affecting 50-90% of adolescent girls. Menstrual cramps are throbbing or cramping pains in the lower abdomen, which can be severe enough to interfere with everyday activities for a couple of days every month. Painful periods start with regular ovulation, about 6–24 months after menarche and may be associated nausea, vomiting, diarrhoea, dizziness, headaches, and muscle cramps.

 

Menstrual issues like irregular periods, heavy flow, prolonged flow along with painful periods can be very distressing and depressing for the young adolescent and they may be unable to cope. She needs support in the form of empathetic education and awareness. Doctor at the adolescent clinic may prescribe appropriate drugs when required

 

Polycystic ovary syndrome (PCOS) is the most common endocrine condition affecting 6–18% of adolescent girls and may manifest with

  • Menstrual irregularity or excessive bleeding
  • Excessive facial & body hair and persistent acne
  • Obesity

 

Normal bodily changes due to puberty and problems due to poly cystic ovaries during adolescence overlap making diagnosis of PCOS challenging

Corner stones in the treatment of PCOS are

  • Maintaining optimal Body Mass Index-This includes weight loss/prevention of weight gain through appropriate Life style modifications like eating healthy food, exercise and less sedentary habits.
  • Medications- like metformin or combined oral contraceptive pill or other medications as recommended by the doctor to normalize periods, treat acne, facial hair etc.
  • Appropriate awareness/education and emotional support through the treatment

 

PUBERTAL ISSUES

 

Puberty- is a phase when a child's body begins changing into that of an adult

  • Breast growth and first period in girls
  • Pubic or underarm hair
  • Rapid growth of bones & muscles
  • Changes in body shape and size
  • Acne
  • Adult body odour
  • Body’s ability to reproduce

 

Precocious puberty is when the pubertal changes happen too soon, before the age of 8 years in girls and before the age of 9 years in boys.

The cause of precocious puberty often can't be found. Treatment for precocious puberty typically includes medication to delay further development.

 

Delayed puberty is when girls have not started to have bodily pubertal changes by the age of 13, or they have attained physical changes of puberty, but their periods have not started by the age of 15 years.

 

Causes of delayed puberty-

  • Natural/physiological delay -Pubertal growth changes begin later than usual in most cases of delayed puberty
  • Lack of body fat/girls being too thin which disrupts the normal process of puberty. This can occur in girls who:
    • undergo intense physical training for a sport, such as running or gymnastics,, swimming and  dancing
    • are undernourished due to long-term illnesses or have an eating disorder, such as anorexia or bulimia 
  • Produce too little or no hormones from their ovaries for various reasons and this is called hypogonadism 

The treatment of delayed puberty involves treating the cause.

 

 

OTHER ISSUES

Adolescence is a phase of struggle to go through the transition from a dependent child to an independent woman facing a different world. During this transition, girls become increasingly conscious of their physical and emotional self and face the following issues

Being conscious of body image- They worry about being overweight, acne, facial hair etc and may get into eating disorders

Self-esteem issues – They either over assert their identity and get into

Conflicts, especially with parents and peers or have low self-esteem leading to shyness, diffidence, phobias, anxiety, depression and self-harm

Emotional Vulnerability - Adolescents want to be liked and accepted by the peers and give in to risky behaviour. They fear rejection and hence may indulge in stealing, alcohol, sex and drugs, just to be part of the group.

The adolescents require a non-judgemental, friendly confidant who would support them appropriately in a comfortable and confidential atmosphere. The Adolescent clinic at Sbobgyn would provide a multidisciplinary team consisting of a gynecologist, pediatrician, dietician and a counsellor who are well trained in adolescent issues to guide and hand hold them through this difficult phase.