Menstrual patterns in the first gynecological year: a systematic review

Gunn, Harriet Mary; Tsai, Meng-Che; McRae, Alexandra; Steinbeck, Katharine S.

doi:10.1016/j.jpag.2018.07.009

Cited by 60Menstrual Health and DisordersHypothalamic control of reproductive hormonesOvarian function and disorders

Menstrual patterns in the first gynecological year: a systematic review

Gunn, Harriet Mary, Tsai, Meng-Che, McRae, Alexandra, Steinbeck, Katharine S.·2018·Journal of Pediatric and Adolescent Gynecology

DOI 10.1016/j.jpag.2018.07.009

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Abstract

Study objective Understanding what constitutes a normal menstrual cycle during the first gynecological year (GY1) is a common concern of adolescents and clinicians. However, limited high-quality evidence exists. We aimed to summarize published literature regarding menstrual and ovulatory patterns in GY1. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Electronic databases (MEDLINE, Pre-MEDLINE, Embase, Web of Science, CINAHL, Cochrane Library) were systematically searched from database inception to 2018. Eligible studies described menstrual cycles, symptoms, or validated ovulatory data in healthy adolescents in GY1. Two authors independently screened studies, extracted data, and assessed methodological quality.Results Twenty-two studies involving more than 2000 adolescents were included. Thirteen recorded menstrual cycle and/or symptom data and 14 measured ovulation. Mean cycle length ranged from 32 to 61 days and decreased throughout GY1. Mean menses length was 4.9 to 5.4 days. Frequent menstrual bleeding was reported in up to 23% of participants, infrequent menstrual bleeding in up to one-third, and "irregular menstrual bleeding" in up to 43%. Dysmenorrhea was reported by 30%-89% of participants. Prevalence of ovulatory cycles identified using luteal phase serum or salivary progesterone or urinary pregnanediol was 0 to 45% and increased throughout GY1. However, all used definitions that would be considered subovulatory in clinical practice.Conclusion Menstrual and ovulatory patterns in GY1 are diverse and differ from those of adults. A transitional phase of menstrual and ovulatory immaturity is common. However, ovulation, irregular cycles, and dysmenorrhea are not uncommon. As such, safe sexual practice should be advocated and prompt medical management should be accessible.

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A 2018 systemic review of menstrual patterns during the first gynecologic year concluded that menstrual and ovulatory patterns are diverse during this time period.
“A 2018 systemic review of menstrual patterns during the first gynecologic year concluded that menstrual and ovulatory patterns are diverse during this time period.”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [135]
In 22 studies involving more than 2000 adolescents, frequent menstrual bleeding (<21 days) occurred in 23% and prolonged menstrual bleeding (>30 to 45 days) occurred in at least 33%.
“In 22 studies involving >2000 adolescents, frequent menstrual bleeding (<21 days) occurred in 23% and prolonged menstrual bleeding (>30 to 45 days) occurred in at least 33% [135].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [135]

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Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls
Witchel, S. F., Oberfield, S. E., & Peña, A. S. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2019-00078 · Cited by 653 · see citing works

Authors: Gunn, H. M., Tsai, M.-C., McRae, A., & Steinbeck, K. S.
Affiliations: The University of Sydney (AU)
National Cheng Kung University Hospital (TW)
Corresponding author: Gunn, Harriet Mary
ORCID: Gunn, Harriet Mary
Tsai, Meng-Che
Steinbeck, Katharine S.
Venue: Journal of Pediatric and Adolescent Gynecology
Publisher: Elsevier BV
Published: 2018-12
Volume: 31
Issue: 6
Pages: 557-565.e6
ISSN: 0932-8610 (ISSN-L)
1083-3188
DOI: 10.1016/j.jpag.2018.07.009
OpenAlex: W2883421150
Cited by: 60
References: 155
Citations by year: 2026: 6 · 2025: 4 · 2024: 14 · 2023: 5 · 2022: 11 · 2021: 6 · 2020: 4 · 2019: 7 · 2018: 2
FWCI: 0.87
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Pediatric and Adolescent Gynecology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords: menstrual cycle, ovulation, menstrual cycle length, menstrual bleeding patterns, dysmenorrhea, luteal phase, progesterone, urinary pregnanediol, menstrual irregularity, sexual health
MeSH terms: Adolescent, Female, Humans, Menarche, Menstrual Cycle, Ovulation, Ovulation Detection, Pregnanediol, Progesterone

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Menstrual patterns in the first gynecological year: a systematic review

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