Family planning in adolescents.

PURPOSE OF REVIEW: As politics continue to shape contraception and abortion care, providers have a responsibility to address the specific needs of the adolescent patient. Here we review the current literature on contraception and abortion in adolescents. RECENT FINDINGS: Shared decision-making among patients, parents, and providers is the cornerstone of successful adolescent family planning. Providers should be aware of local state regulations related to consent in minors. When provided directive and noncoercive contraception counseling at no cost, adolescents are motivated and effective decision-makers in their care. Long-acting reversible contraceptives should be offered as the first-line method of contraception in adolescents. SUMMARY: Family planning in adolescents presents unique challenges to obstetrician-gynecologists. Improved access to contraception and abortion services is significantly lowering unintended pregnancies rates in adolescents, but more data assessing the effectiveness of interventions in marginalized communities are needed.

Menstrual suppression for adolescents.

PURPOSE OF REVIEW: The purpose of this review is to highlight the recent literature and emerging data describing clinical situations in which menstrual suppression may improve symptoms and quality of life for adolescents. A variety of conditions occurring frequently in adolescents and young adults, including heavy menstrual bleeding, and dysmenorrhea as well as gynecologic conditions such as endometriosis and pelvic pain, can safely be improved or alleviated with appropriate menstrual management. RECENT FINDINGS: Recent publications have highlighted the efficacy and benefit of extended cycle or continuous combined oral contraceptives, the levonorgestrel intrauterine device, and progestin therapies for a variety of medical conditions. SUMMARY: This review places menstrual suppression in an historical context, summarizes methods of hormonal therapy that can suppress menses, and reviews clinical conditions for which menstrual suppression may be helpful.

Adnexal torsion in a pediatric population: Acute presentation with question of chronicity.

OBJECTIVES: To establish the frequency of torsion with multiple twists of the adnexa in girls 19 years old and younger surgically diagnosed with torsion. STUDY DESIGN: A retrospective chart review using an institutional tool to review charts of female patients 19 years old or younger who presented with acute abdominal pain leading to a surgical diagnosis of adnexal torsion. RESULTS: Of 141 pediatric patients with torsion, 61 (43%) had documentation of multiple twists, with 2 to 12 rotations present. 33% reported acute pain (<24 hrs) whereas most (67%) had pain > 24 h up to 4 weeks without abatement (23%) or experienced discrete episodes with pain resolution between episodes (44%). Even when vascular flow was demonstrated, multiple twists were frequently found (14/36 = 39%). When multiple twists were documented, more patients had an extirpative procedure due to a nonviable appearing ovary than when a single or unstated number of twists twist was found, although the results were not statistically significant (53.5% vs 42.9%, p = 0.098). CONCLUSIONS: Forty-three percent of girls presenting with symptoms of torsion had multiple twists in the adnexa. Many had provided a history of previous similar episodes of pain and presentation to emergency departments, suggesting possible previous undiagnosed episodes of torsion. Earlier diagnosis may provide a better opportunity for ovarian conservation prior to a recurrent torsion. Further study may reveal whether multiple twists are more likely to result in a nonviable ovary and need for oophorectomy.

Daily, weekly, seasonal and menstrual cycles in women's mood, behaviour and vital signs.

Dimensions of human mood, behaviour and vital signs cycle over multiple timescales. However, it remains unclear which dimensions are most cyclical, and how daily, weekly, seasonal and menstrual cycles compare in magnitude. The menstrual cycle remains particularly understudied because, not being synchronized across the population, it will be averaged out unless menstrual cycles can be aligned before analysis. Here, we analyse 241 million observations from 3.3 million women across 109 countries, tracking 15 dimensions of mood, behaviour and vital signs using a women's health mobile app. Out of the daily, weekly, seasonal and menstrual cycles, the menstrual cycle had the greatest magnitude for most of the measured dimensions of mood, behaviour and vital signs. Mood, vital signs and sexual behaviour vary most substantially over the course of the menstrual cycle, while sleep and exercise behaviour remain more constant. Menstrual cycle effects are directionally consistent across countries.

Practical Tips for Intrauterine Device Counseling, Insertion, and Pain Relief in Adolescents: An Update.

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to "practical tips" for clinicians, on the basis of an update of the available literature as well as the author's clinical experience. Counseling about contraceptive choices, preventive guidance about possible side effects, informed consent, and pain management are addressed to promote successful use of this long-acting reversible contraption option.

Assessment of menstrual health status and evolution through mobile apps for fertility awareness.

For most women of reproductive age, assessing menstrual health and fertility typically involves regular visits to a gynecologist or another clinician. While these evaluations provide critical information on an individual's reproductive health status, they typically rely on memory-based self-reports, and the results are rarely, if ever, assessed at the population level. In recent years, mobile apps for menstrual tracking have become very popular, allowing us to evaluate the reliability and tracking frequency of millions of self-observations, thereby providing an unparalleled view, both in detail and scale, on menstrual health and its evolution for large populations. In particular, the primary aim of this study was to describe the tracking behavior of the app users and their overall observation patterns in an effort to understand if they were consistent with previous small-scale medical studies. The secondary aim was to investigate whether their precision allowed the detection and estimation of ovulation timing, which is critical for reproductive and menstrual health. Retrospective self-observation data were acquired from two mobile apps dedicated to the application of the sympto-thermal fertility awareness method, resulting in a dataset of more than 30 million days of observations from over 2.7 million cycles for two hundred thousand users. The analysis of the data showed that up to 40% of the cycles in which users were seeking pregnancy had recordings every single day. With a modeling approach using Hidden Markov Models to describe the collected data and estimate ovulation timing, it was found that follicular phases average duration and range were larger than previously reported, with only 24% of ovulations occurring at cycle days 14 to 15, while the luteal phase duration and range were in line with previous reports, although short luteal phases (10 days or less) were more frequently observed (in up to 20% of cycles). The digital epidemiology approach presented here can help to lead to a better understanding of menstrual health and its connection to women's health overall, which has historically been severely understudied.

Menstruation in adolescents: what's normal, what's not.

The conventional wisdom about menstruation in adolescents, perpetuated in textbooks, requires updating. Recently published national surveys and reviews of large historical databases provide information about menstruation in adolescents, including the following: (1) Girls are experiencing earlier pubertal development than previously noted, suggesting that guidelines for the evaluation of potentially pathologic precocious puberty be reassessed. (2) There are racial differences in pubertal development, with African American girls experiencing earlier signs than Caucasian girls, and Mexican American girls intermediate in pace. (3) The absence of pubertal development by age 14 is associated with a high probability of conditions with impaired reproductive potential. (4) Absence of menarche by age 15 is statistically uncommon and should be evaluated. (5) Parameters for normal menstrual cyclicity indicate that most menstrual cycles for adolescents are between approximately 20 and 45 days. (6) Because menstrual cycles outside of this range are statistically uncommon, consideration should be give to evaluating adolescents with bleeding that is either too frequent or too infrequent. (7) A number of conditions with the potential for significant sequelae in adulthood can present as abnormal menses in adolescence, and thus merit early diagnosis and management.

Group A Streptococcus vulvovaginitis in breastfeeding women.

Group A beta-hemolytic streptococcus-associated vulvovaginitis is uncommon in adult women. Clinicians should include group A beta-hemolytic streptococcus as a possible cause of vulvovaginal symptoms in breastfeeding women. Along with appropriate antibiotic therapy, vaginal estrogen therapy may be considered to diminish susceptibility to recurrent infection in women with vaginal atrophy.