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It is normal to have irregular menstruation within the next 2 years after menarche and it is unnecessary to examine this. Sometimes this period may be even loger. The reason of irregular menstruation in the first years is the poor development of the communication mechanism between hypothalamus- pituitary gland (the gland which excretes the hormone that activates ovaries) and ovaries.  Normal menstruation is once in 28 days (occurs between 21 – 35 days), lasts in 4 to 5 days (more than 2 days, less than 8 days) and total  amount is less than half of the tea glass (approximately 50 ml).

Attention: In cases when menarche doesn’t develop within the first 3 years after the breast developments starts , hairing problem accompanying with irregular menstruation is present, eating problem exists and menarche  doesn’t develop till the age of 16 , then the condition should be evaluated.

Amenorrhea : is the condition in which  secondary sexual characteristics don’t maturate, menarche doesn’t develop or absence of menarche in the patient in whom secondary sexual characteristics have maturated (primary amenorrhea) or absence of menstration more than 6 months (secondary amenorrhea).

Dysmenorrhea (painflul menstruation):  Painful menstruation which develop in the onset of menstruation and not lasting 1 to 2 days without increasing severity are generally harmless (Primary amenorrhea). Painful menstruation which develop later with an increasing severity in time (secondary amenorrhea) may be the  precursor of other diseases and it is important to diagnose it on time.

Diseases which may be related to secondary amenorrhea:

Endometriosis, congenital cervical anomalies, pelvic infections, ovarian cysts, myomas.

Treatment of dysmenorrhea starts with hot pack and simple painkillers (paracetamol) and if not sufficient, painkillers such as NSAID may be started, if still not sufficient, combined oral contraceptives  (birth control pills)may be used in patients above 16 years old.

Severe bleeding: Ovulation and menstruation may be irregular within the firt 2 years due to the poor development of the communication mechanism between hypothalamus- pituitary gland (the gland which excretes the hormone that activates ovaries) and ovaries. (Anovulatory cycles). Severe bleedings may develop due to this irregular ovulation (dysfunctional uterine bleeding). In this case, ther eis no appearant reason which may cause bleeding (myoma, cyst, polyp, pregnancy, etc). Estrogen treatment is required in severe bleedings and generally prefferred medications are combined oral contraceptives (birth control pills) and generally these are started in high doses and the doses are decreased in time. While making differential diagnosis, pregnancy, polycystic ovarian disease, adrenal gland disease, hyperprolactinemia, hypothyroidism, hypothalamic-pituitary-ovarian axis distortion of (eating disorders, stress, excessive exercise), medication use, fibroids, cysts, polyps, infection, congenital anomalies, trauma, sexual harassment should be taken into consideration.

Menorrhagia: Sometimes, long-lasting menstruation (more than 8 days) may develop and these may cause anemia, in this case it is important not to miss out hereditary bleeding problems (Von Willebrand Disease, thrombocytopenia, coagulation disorders. Painkillers generally named as NSAID reduce a quarter of the bleeding amount.


Reasons for vaginal bleeding in small girls: Just after birth, vaginal bleeding may develop in newborn girl babies due to absence of hormones coming from the mother and this is normal. Small children have tendency to put small materials to their body spaces, rarely vagina is also one of these organs. Children run and jump, they fall to the ground and of course geniral organs may exposure to trauma. Vulvovaginal infections may cause bleeding, too. Cancers of the vagina (emrional rhabdomyosarcoma) may cause bleeding rarely, too.