Adolescent Gynaecology Guidance for GPs
Guidance for GPs managing adolescent menstrual and gynaecological symptoms.
Adolescent Gynaecology Support
While serious gynaecological pathology in childhood and adolescence is rare, we appreciate that gynaecological symptoms can cause significant distress, in particular to those students studying for upcoming examinations.
In so far as possible we are offering telephone consultations with parents and young women.
Urgent referrals will be reviewed and it may be possible to offer advice remotely.
Menstrual Problems in Adolescents
The majority of adolescents attending our clinics do so because of menstrual problems. These are very common in adolescence and are mostly related to anovulatory cycles.
We would recommend continuing current treatments, such as the Combined Oral Contraceptive Pill (COCP), if the treatment is working well.
Keeping a menstrual or symptom diary/app can also be very helpful.
Pain Relief and Symptom Management
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Ibuprofen: 10mg/kg (maximum 400mg) three times daily
- Mefenamic Acid: 500mg three times daily (for those over 12 years)
NSAIDs may reduce menstrual blood loss by approximately 20% (Cochrane evidence).
Important: Encourage early commencement of regular analgesia.
Tranexamic Acid
- 1g four times daily
- 500mg four times daily if under 50kg
Can reduce menstrual flow by 40–50% compared with placebo (Cochrane evidence).
Hormonal Management
Cyclical progesterone can be particularly helpful for younger girls who do not require contraception.
Progesterone Options
- Norethisterone: 5mg BD–TDS, Days 14–28
- Duphaston: 10mg BD, Days 14–28, continue for 6 months
- Medroxyprogesterone Acetate: 2.5–10mg OD, Days 14–28
Combined Oral Contraceptive Pill (COCP)
- 30mcg COCPs generally provide better cycle control than 20mcg pills.
- Extended or back-to-back use can be particularly effective for cyclical symptoms.
- Breakthrough bleeding can occur; a 4-day break may be helpful if bleeding persists for more than 4 days.
Long-Acting Reversible Contraception (LARC)
LARC methods may be appropriate for some adolescents.
Useful Links
Find further information and support from trusted organisations.
The British Society for Paediatric and Adolescent Gynaecology↗