9 - Menarcheand associated problems

Summary

A review of the qualitative literature on young women's experiences of menarche revealed that menarche had a major impact on lives physically, psychologically, socially and culturally. Pubertal development before the age of eight and menarche before the age of nine should be investigated by an endocrinologist. Early menarche is associated with an increase in all cancer mortality, whereas late menarche is associated with increased risk of osteoporosis and fractures. Sometimes girls will continue to have heavy bleeding on combined hormonal contraception (CHC). A recent addition to treatment options is oestradiol valerate with dienogest (Qlaira) with a license to treat heavy menstrual bleeding. The authors have found it useful in the treatment of peri-menarchal dysfunctional uterine bleeding (DUB) and also useful for young girls who find it difficult to tolerate oestrogenic side effects including headache and nausea.