Menstruation: The 6th Vital Sign
Posted 5/27/2016 by UHBlog
Medical personnel have routinely assessed a patient’s five vital signs: body temperature, blood pressure, pulse, respiratory rate and pain. Now, pediatricians are urged to check a sixth vital sign at every adolescent girl’s well visit.
“Normal menstruation happens when health is generally good and can go awry when health is not good,” says gynecologist/obstetrician Marjorie Greenfield, MD. “The message is for pediatricians to be asking about menstruation and to pay attention if a girl’s period is not normal.”
Menstruation-related health concerns are not confined to adolescent girls. Both adolescents and women should contact their doctors if they experience any of the following symptoms:
- Amenorrhea – or missed periods, especially if it happens three or more times. Keep in mind its common for girls to have irregular periods during the first two years of menstruation, so don’t automatically panic if this happens. But do mention it to your doctor.
- Heavy flow, requiring the need to change pads or tampons every two hours for seven or more days. It’s normal for bleeding to be heavier at the beginning of a period, but it should taper off after a couple of days.
- Intense cramps that precede menstruation by a week or that worsen after the second day of bleeding. It’s okay to experience cramps during the first two days, then they should lessen and disappear.
According to Dr. Greenfield, irregular periods may signal these health concerns:
- Calorie deficit – “The classic situation is when a young competitive athlete, like a runner or gymnast, loses her period and everyone believes that’s just what happens to athletes,” Dr. Greenfield says. “Actually, it means she’s not getting the calories her body needs, so her reproductive system ‘thinks’ she’s not well enough to get pregnant and it shuts down.” The calorie deficit may not come solely from a lack of nutrition; it may be sign of excessive exercise.
- Eating disorders – Missed periods can be caused by anorexia nervosa, bulimia or other eating disorders.
- Obesity – Menarche, or a girl’s first period, typically occurs around age 12, but some girls are getting their period as young as 7 or 8 years old. While acknowledging there’s a wide range of “normal,” some medical experts believe obesity may be a factor in early menarche.
- Stress fractures – Girls and women of childbearing age who don’t menstruate have an increased risk of stress fractures. This is especially true in athletes.
- Polycystic ovarian syndrome (PCOS) – Missed periods and abnormal bleeding may indicate the presence of this hormonal imbalance that causes small ovarian cysts. It’s important to diagnose and treat PCOS because it's commonly associated with diabetes. It may also lead to infertility, depression, acne, dark pigmentation around the neck, irregular hair growth and other symptoms.
- Brain tumor – Be assured that missed periods are caused by brain tumors in only the rarest of cases, Dr. Greenfield says.
- Pregnancy – Some adolescents – and even grown women – don’t consider the possibility their missed periods may be due to pregnancy.
“Younger adolescents, especially, are concrete thinkers who can be confused by what they wish to be true and what is true,” Dr. Greenfield says. “Sometimes families are not aware a young girl is pregnant until she is well into it.”
Marjorie Greenfield, MD is chief of the division of general obstetrics and gynecology at UH MacDonald Women’s Hospital. You can request an appointment with Dr. Greenfield or any other University Hospitals doctor online.