Melissa Andrzejak, MD

Adolescence, simply defined, is the state or process of growing up… sounds easy enough. One’s body knows what to do: eat, sleep, drink and one day, as if by magic, it wakes up and is different. Taller, curvier… ahh, the joys of adolescence. But, what about those other changes, the ones we’re not so eager to discuss: changes in mood, acne, menstruation. Is this normal? Though the simple answer, in most cases, is 'yes,' there are many topics and questions a healthcare provider familiar with adolescent women’s health can help to address.

While there is no set age or reason to begin routine care with a women’s health professional, the American Congress of Obstetricians and Gynecologists recommends adolescents establish care between the ages of 12 and 15. Although this young age may seem surprising, a visit to specifically discuss the changing needs of an adolescent woman can be very educational. By initiating this relationship early in one’s reproductive life, patients and physicians are more easily able to bridge communication barriers, particularly regarding the sensitive issues which arise in the course of care for adolescent women.

Unfortunately, the fear of one’s first gynecologic visit deters many young women from going to the doctor. A visit to a gynecologist does not necessarily mean a pelvic exam will be performed. In fact, a first visit is sometimes just a good chance to talk about health, healthy behaviors and answer questions a young woman may not feel comfortable asking anyone else. Women who are educated regarding their reproductive health and sexuality are less likely to engage in high-risk behaviors and are better able to make informed choices.

In recent years recommendations have changed for immunizations and routine health screening in the adolescent population. It is recommended that all young women be administered an HPV vaccine series. HPV (human papiloma virus) is the main cause of abnormal pap smears. The HPV vaccine is recommended between ages 11-12, though it can be given up to age 26. Though the vaccine will not protect against all forms of HPV, it does offer protection against the two most common forms of high-risk HPV which cause cervical cancer. In addition, a tetanus, diphtheria, pertussis (Tdap) booster is recommended for anyone not immunized in the last five years. All adolescents should be immunized against Hepatitis B if not given in early childhood.

Initial visits can include a pelvic exam in certain situations. This may involve an external exam only or a gentle internal exam depending on a patient’s health history or concern. A pap smear is just part of the pelvic exam and consists of collecting cells from the cervix and sending those cells for laboratory analysis. Newer recommendations now advise a delay in routine pap smear screening until age 21. All sexually active adolescent women should be offered screening for sexually transmitted diseases including Chlamydia and Gonorrhea.

In addition, there are many situations in which an adolescent woman may seek care for a specific problem or need. Common reasons to consult with your women’s health professional are: concerns regarding the menstrual cycle, pain in the pelvic region, overall sexual health, or questions about normal growth and development.

In the case of heavy or irregular menstruation, there exists a broad spectrum of normal for young women. This is especially true of the first one to two years following menarche (a woman’s first period.) In the adolescent patient, the interval between periods may fall outside of the typically accepted normal range due to ongoing development of hormone producing centers in the brain.

Frequently missed school or participation in sports due to heavy menstrual bleeding or pelvic pain should be discussed with a physician. Any woman experiencing bleeding so heavy as to prompt evaluation in an urgent care facility or emergency department should receive follow up by a thorough evaluation in her doctor’s office.

More information on adolescent heath and other women’s health topics can be found on the American Congress of Obstetricians and Gynecologists website at: http://www.acog.org. Information on immunizations and immunization safety can be found on the Centers for Disease Control website at: http://www.cdc.gov.

Melissa Andrzejak, MD, is an obstetrician/gynecologist at IHA Ann Arbor OB/GYN. Dr. Andrzejak has clinical interest in minimally-invasive and laparoscopic gynecologic surgery, vaginal surgery, well-woman care and adolescent medicine. IHA Ann Arbor OB/GYN - Arbor Park is located at 4940 W. Clark Road, Suite 100, Ypsilanti, MI 48197. Dr. Andrzejak can be reached at 734-434-0477. For other IHA Ann Arbor OB/GYN locations or for more information please visit www.ihacares.com.