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Referrals to Adolescent Gynaecology
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F Martyn, D Hayes-Ryan, O Sheil
National Maternity Hospital, Holles St, Dublin
Objectives
Methods
Adolescence is a period of great change
in a young persons life. As far back in
the literature as 1964 1, it was
recognised that much physical,
emotional, sexual and social issues have
the potential to make this period in life
very traumatic.
We retrospectively analysed the charts
of 138 patients attending the adolescent
gynaecology outpatient clinic in the
National Maternity Hospital, Holles St,
Dublin, Ireland. The general practitioner
referral letter was reviewed and the
reason for referral of the young patient
recorded. We then went on to review the
weight of the patient, the BMI, the final
diagnosis and investigations performed,
if any, and the results.
Unfortunately issues that affected
adolesents in the 1960s have changed
considerably. Social medias endorse the
perfect body image and transmit the
minuate of ordinary life with the world
leaving no room for the shyness or any
deviation from the norm. Thus it is
essential that these young patients are
seen by medical staff with the
knowledge and skill to clarify what can at
times be complex issues. Treatment
options have fortunately improved with a
wide variety of hormonal and nonhormonal medications available.
We aimed to examine what General
Practioners were referring into the
adolescent gynaecology clinic in a
tertiary referral centre and to see if
particular education was needed in one
area to prevent unnecessary
investigations. We also wanted to look at
what investigations were yielding
abnormal results and how often weight
and Body Mass Index (BMI) were
recorded accurately in charts.
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The weight range for these patients was
from 14.5 kg for a 3-year-old patient to a
high of 115.5 kg for a 17-year-old
patient. There were 68 BMIs recorded
2
with a range of 15 to 46 kg/m . Eleven
2
patients had a BMI over 25 kg/m and 11
had a BMI over 30 kg/m2, categorising
them as overweight and obese
respectively. (Figure 2)
Conclusions
Results
138 patients’ charts were analysed. The age
range of the patients was from 3 years to 18
years of age. The majority of referrals
related to dysmenorrhoea and menorrhagia
– 61/138 (44.2%). The next most common
reason for referral was an irregular cycle –
14/138 (10.1%), followed by vulval pain
12/138 (8.6%). There were 9 cases of
primary amenorrhoea and 10 cases of
secondary amenorrhoea. There were 5
referrals for perceived elongated labia
minora.(Figure 1)
With regards to treatment, 34.8% (48/138)
were treated with the oral contraceptive pill
(OCP), 23.9% (33/138) needed no treatment
and 18.8% (26/138) were treated with luteal
phase progesterone. Only 2 patients required
treatment with the OCP and then
laparoscopy. The most common diagnosis
sited was anovulatory cycles – 37% (51/138).
No medical cause was found in 19.6%
(27/138) and polycystic ovarian syndrome
was found in 15.2% (21/138).
Figure 2
88.4% (122/138) had a normal
examination with 5.8% (8/138) having a
finding of hirsuitism and acne. 1.4%
(2/138) had a finding of elongated labia.
(Figure 3)
The majority of patients were referred in
for management of menstrual
disturbance: menorrhagia,
dysmenorrhoea or an irregular cycle.
This is different from a large study by
McGreal et al, which found the most
common reasons for referral to a British
paediatric and adolescent service to be
in descending order: recurrent
vulvovaginitis, labial adhesions and
2
dysmenorrhoea/menorrhagia . There
appears to be a worryingly high level of
overweight and obese adolescents
attending this clinic. Improved recording
of weight and BMI will help identify
adolescents in need of dietary advice
and further long term follow up.
References
Figure 3
Figure 1
McGreal S, Wood PL. A study of paediatric and adolescent gynaecology
services in a British district general hospital. BJOG : an international journal
of obstetrics and gynaecology. 2010;117(13):1643-50. Epub 2010/11/17.
2.
Medovy H. Problems of Adolescence. Canadian Medical Association
journal. 1964;90:1354-60. Epub 1964/06/13.