Prevention and Management of Pregnancy in Adolescents with Endocrine Disorders.

Because 83% of adolescent pregnancies among teens 15 to 19 years old are unintended and because adolescents with chronic medical conditions are as likely to be sexually involved as are healthy teens, preventing unintended pregnancies among teens with chronic endocrine conditions, including diabetes mellitus (both types 1 and 2), PCOS, and thyroid dysfunction, is critically important. Evidence-based guidelines are available to assist with assessment of the risks versus the benefits of specific options for contraception in teens with these and other medical conditions. In many teens, including those with chronic medical conditions, the top-tier contraceptive methods--implants and intrauterine devices--represent the most effective, safest, and most successful contraceptive options for adolescents.

Menstrual suppression for adolescents.

Purpose Of Review: The purpose of this review is to highlight the recent literature and emerging data describing clinical situations in which menstrual suppression may improve symptoms and quality of life for adolescents. A variety of conditions occurring frequently in adolescents and young adults, including heavy menstrual bleeding, and dysmenorrhea as well as gynecologic conditions such as endometriosis and pelvic pain, can safely be improved or alleviated with appropriate menstrual management.

Recent Findings: Recent publications have highlighted the efficacy and benefit of extended cycle or continuous combined oral contraceptives, the levonorgestrel intrauterine device, and progestin therapies for a variety of medical conditions.

Use of levonorgestrel intrauterine system for medical indications in adolescents.

The levonorgestrel intrauterine system (LNG-IUS) is an underused contraceptive method in adolescent populations. In addition to being a highly effective, reversible, long-acting contraception, the LNG-IUS has many noncontraceptive health benefits including reduced menstrual bleeding, decreased dysmenorrhea and pelvic pain related to endometriosis, and menstruation suppression in teens with physical or developmental disabilities. The LNG-IUS can also provide endometrial protection in teens with chronic anovulation, and may be used to treat endometrial hyperplasia and cancer.

Practical tips for intrauterine devices use in adolescents.

The American Congress of Obstetricians and Gynecologists (ACOG) has endorsed intrauterine devices (IUDs) as first-line contraceptive choices for both nulliparous and parous adolescents. The committee opinion did address some of the practical elements of IUD use in adolescents, but because these practical concerns may be barriers to use for both teens and clinicians, this review is devoted to "practical tips," based on the available literature as well as the author's clinical experience. Counseling, informed consent, techniques of pain management, and preventive guidance about possible side effects are addressed in an effort to promote successful use of this long-acting reversible contraception (LARC) option.

Gynecologic knowledge is low in college men and women.

Study Objective: Although men may influence women's reproductive choices, little is known about men's knowledge regarding gynecologic matters (eg, sex, anatomy, and contraception). This study aimed to evaluate the level of gynecologic knowledge among college students, particularly to investigate the differences in knowledge between men and women.

Design, Setting, Participants: We administered a survey to assess knowledge of sex, contraception, and female anatomy to college students at a Midwestern university during the spring 2010 semester.

Menstrual suppression with the levonorgestrel intrauterine system in girls with developmental delay.

Study Objective: To describe the experiences of 21 girls with developmental delay accompanied by multiple other medical problems, seen over a 3-year interval, who underwent insertion of the levonorgestrel intrauterine system (LNG-IUS) for menstrual suppression.

Study Design: Retrospective chart review.

Setting: A referral pediatric and adolescent gynecology clinic within a tertiary care medical center with referrals from community pediatricians, pediatric subspecialists including developmental and behavioral pediatricians, community gynecologists, and adolescent medicine specialists.

A family systems approach to primary ovarian insufficiency.

Receiving the diagnosis of Primary Ovarian Insufficiency (POI) can be emotionally difficult and confusing for young girls and their families. Parents need assistance in knowing how to help their daughters understand and live with the diagnosis in a way that allows for healthy growth and development. This paper provides a starting point for parents and clinicians with "Tips and Tools for Talking: Helping Your Daughter Understand Primary Ovarian Insufficiency".

IUDs and adolescents--an under-utilized opportunity for pregnancy prevention.

Most pregnancies in adolescents are unintended and preventable if contraception were utilized. IUDs provide an under-utilized highly effective form of contraception. IUDs are appropriate for nulliparous women, including adolescents.

Bariatric surgery and adolescent gynecology.

Purpose Of Review: This review summarizes the impact of bariatric surgery on gynecologic complications in the context of the extremely obese adolescent and reviews contraceptive considerations before and after adolescent bariatric surgery.

Recent Findings: Eighteen percent of children and adolescents have a body mass index greater than the 95th percentile, with 4% of adolescents being greater than the 99th percentile. Gynecologic morbidities identified in obese adolescents include anovulatory complications such as acute menorrhagia, polycystic ovary syndrome and endometrial hyperplasia, and cancer.

US findings of adnexal torsion in children and adolescents: size really does matter.

Background: Adnexal torsion is rare, and symptoms are nonspecific. Clinicians often rely on US examinations to evaluate girls with abdominal or pelvic pain.

Objective: To determine which sonographic findings can predict adnexal torsion by comparing pediatric and adolescent patients with surgically confirmed torsion (cases) to those without torsion (controls).

Contraceptive behaviors in adolescents.

A wide range of factors influence adolescents' contraceptive behaviors, from personal characteristics to family context to social support to knowledge about and access to contraception. Improving knowledge about contraception and counseling about successful contraceptive use can be helpful in decreasing the remarkably high US rates of adolescent pregnancy. Encouraging the postponement of sexual activity until an individual adolescent is developmentally capable of participating in a mature, healthy, mutually respectful relationship that incorporates effective contraception clearly is a goal that most clinicians, parents, teachers, and other responsible adults can support.

Overview of contraception.

The United States has the highest rates of adolescent pregnancy of any Western industrialized country. Addressing these high rates and preventing adolescent pregnancy are complicated tasks. This article addresses some of the issues involved with preventing adolescent pregnancy, focusing on contraception.

Female genital mutilation.

Purpose Of Review: The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation.

Recent Findings: The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor.

Adnexal torsion in pediatric and adolescent girls.

Purpose Of Review: This review provides timely information to assist in solving the diagnostic dilemma of adnexal or ovarian torsion. Knowledge and awareness of current literature is essential to help clinicians improve diagnostic accuracy and avoid potentially catastrophic consequences, including loss of ovarian tissue and function.

Recent Findings: This article reviews recent evidence regarding radiologic tools used for efficient, timely diagnosis and management strategies for adnexal torsion, including detorsion.

Oral contraceptives and the management of hyperandrogenism-polycystic ovary syndrome in adolescents.

Appropriate management of polycystic ovary syndrome in adolescents depends on recognizing the syndrome, which can have a variety of presenting complaints and must be differentiated from other causes of hyperandrogenism, as well as not dismissed as "normal adolescence." Oral contraceptives have long been considered the first line of treatment by obstetrician/gynecologists and have many advantages in treating the aspects of PCOS that are most bothersome to teens. Because of the potential risk for cardiovascular disease, early diagnosis and management may be helpful in minimizing the risk of the early metabolic correlates of adult disease.

Clinical and metabolic findings in adolescent females with hyperandrogenism.

Background: The purpose of this study was to characterize the population of adolescent females with laboratory evidence of hyperandrogenism and to explore clinical and laboratory features that may facilitate the diagnosis and management of this condition. We further investigated these characteristics by race, weight, and type of androgen abnormality.

Methods: A 4-year retrospective chart review was undertaken.