# Adolescent Gynaecology Basics

> Adolescent gynaecology notes for NEET-PG Obstetrics and Gynaecology: normal cycle ranges, dysmenorrhoea, anovulatory bleeding, vWD screen, POCSO and MTP.

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- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Adolescent Gynaecology Basics", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/adolescent-gynaecology-basics

## Direct answer

Adolescent gynaecology (WHO defines adolescence as 10-19 years) rests on knowing what is normal before treating what is not: cycles of 21-45 days are physiological for several years after menarche (mean age in India 12-13), most cycles are anovulatory in the first year, and cycles longer than 90 days are abnormal even in the first gynaecological year. The three presenting complaints structure the topic: dysmenorrhoea (commonest — NSAIDs first line, endometriosis when atypical or refractory), heavy bleeding (screen for bleeding disorder — von Willebrand disease in up to a fifth of hospitalised adolescents — and always pregnancy), and irregular bleeding from the immature hypothalamo-pituitary-ovarian axis; confidentiality, consent under POCSO and teenage-pregnancy prevention frame the Indian consultation.

## What you must remember

- **Normal parameters:** menarche 10-16 years (mean 12-13); cycle 21-45 days; flow 3-7 days; by three years post-menarche most cycles are ovulatory — utter irregularity beyond 2-3 years needs a cause.
- **The 90-day rule:** cycles consistently over 90 days warrant evaluation even in the first year — polycystic ovary syndrome, thyroid, hyperprolactinaemia, eating disorder, pregnancy.
- **Dysmenorrhoea:** primary — NSAIDs (mefenamic acid, ibuprofen) 70-80 per cent effective, heat, TENS, combined pill; secondary suspects — endometriosis (never normalise disabling pain), genital tuberculosis in India, obstructed outflow anomalies.
- **Heavy bleeding:** pregnancy test first, then complete blood count, ferritin, thyroid, coagulopathy screen (von Willebrand panel — factor VIII, antigen and activity), since bleeding disorders underlie up to 20 per cent of hospitalised adolescents; treat with tranexamic acid, NSAIDs, a monophasic pill (three times daily in acute flooding, tapered), a levonorgestrel intrauterine system, plus iron.
- **Adolescent polycystic ovary syndrome:** diagnose cautiously — Rotterdam criteria plus at least two years post-menarche; weight management before drugs.
- **Ovarian masses:** functional cysts dominate and regress; torsion is the emergency (sudden pain, vomiting, Doppler); dermoid is the commonest adolescent ovarian tumour.
- **The legal frame:** POCSO 2012 criminalises all sexual activity under 18, even consensual, with mandatory reporting; the MTP Act requires guardian consent for a minor's termination — care, confidentiality and law must be balanced.
- **Programme hooks:** Rashtriya Kishor Swasthya Karyakram adolescent-friendly clinics with Saathiya peer educators, menstrual hygiene schemes, HPV vaccination at 9-14 years.

## Two teenagers, two very different plans

Girl one, 14, eight months past menarche, bleeds every 35-50 days for eight days, haemoglobin 10.2, eats poorly. The plan: a menstrual diary, iron, nutrition, reassurance with review — the axis is maturing and the likeliest treatment is time, with the 90-day and two-to-three-year rules as tripwires. Girl two, 16, soaks a pad an hour for two days each cycle since menarche, haemoglobin 7.8, bruises easily; her mother had a hysterectomy at 30 for "bleeding". Her workup is different: pregnancy test, complete blood count and ferritin, thyroid, coagulopathy screen — bleeding from menarche plus family history raises von Willebrand disease, found in up to a fifth of hospitalised adolescents. Treatment layers: intravenous ferric carboxymaltose, tranexamic acid and mefenamic acid for the cycles, and a monophasic combined pill tapered from three times daily during floods to once daily — or a levonorgestrel intrauterine system for durable control. The contrast is the curriculum: same age, same complaint, one needs a calendar and iron, the other a haematologist.

## The Indian adolescent clinic

Adolescent gynaecology in India carries burdens Western texts underweight. Teenage pregnancy remains substantial — roughly 7 per cent of women aged 15-19 in NFHS-5 were already mothers or pregnant — driven by early marriage despite law, stacking anaemia, hypertensive risk and dropout. Menstrual health is a public-health subject: school absenteeism during periods is documented, the government's menstrual hygiene scheme distributes subsidised pads through ASHAs and schools. The differential Western chapters forget: genital tuberculosis, endemic in India, causes pelvic pain and later infertility — consider it in refractory dysmenorrhoea. The legal frame shapes practice: POCSO's mandatory reporting sits uneasily with confidential adolescent care, and Indian guidance advises proceeding with treatment, counselling and child-protection assessment while meeting reporting duties; RKSK adolescent-friendly clinics with Saathiya peer educators are the system's answer to access. The viva trio: the 90-day rule, the coagulopathy screen, and the commonest cause of adolescent irregular bleeding (anovulation from the immature axis).

## Frequently asked questions

### When does adolescent menstrual irregularity need investigation?

Cycles consistently over 90 days (even in the first gynaecological year), heavy bleeding from menarche, persistent irregularity beyond 2-3 years.

### What is first-line treatment for primary dysmenorrhoea?

NSAIDs such as mefenamic acid or ibuprofen started early, with heat and exercise; combined pills when NSAIDs fail or contraception is needed.

### Why screen for von Willebrand disease in adolescent heavy bleeding?

Hereditary bleeding disorders, chiefly von Willebrand disease, underlie up to a fifth of hospitalised adolescents with heavy bleeding; hormones alone cannot manage what haematology must.

### How is polycystic ovary syndrome diagnosed in adolescents?

Cautiously — Rotterdam features plus two years post-menarche; weight management and lifestyle before drugs.

### What must a clinician know about POCSO in adolescent care?

Any sexual activity below 18 is legally an offence regardless of consent, with mandatory reporting; care proceeds alongside child-protection assessment under the Act.