Teenage period problems and adolescent gynaecology in Chennai

Adolescent gynaecology is care for girls from around 10 to 19. Puberty follows a set order: breast development, then pubic hair, a growth spurt, and the first period (menarche) about two years after the breasts begin, usually between 11 and 14 in India.

The first two years of periods are irregular in most girls, because many cycles pass without an egg being released. Gaps of 21 to 45 days and the odd missed month are normal then. Some patterns are not. No period by 15, or no breast development by 13, is delayed puberty (primary amenorrhoea) and needs tests.

PCOD (polycystic ovary disease, also called PCOS) often shows up in the teens as periods that stay irregular beyond two years, with weight gain, pimples, extra facial hair or a dark neck.

The visit starts with a conversation, not an examination. Dr. Ragavi asks when the breasts began developing, when the first period came, the pattern since, pads used on heavy days, and about weight and diet. A period diary kept on the phone for two or three months is the most useful thing to bring.

Examination is usually external: height, weight, blood pressure and a gentle check of the tummy. An internal examination is not done in a girl who has not been sexually active unless there is a specific reason, and it is explained first. A parent may stay throughout, a lady attender is always present, and consent is asked of the girl herself.

Tests are chosen for the problem: haemoglobin for heavy bleeding, with a clotting screen if it has been heavy since the first period; thyroid and prolactin for missed periods; sugar, insulin and male hormone levels if PCOD is suspected. An ultrasound scan of the uterus and ovaries is done through the tummy with a full bladder, never internally in a teenager.

Most teenagers need an explanation, reassurance and a plan rather than strong medicines.

Irregular periods and PCOD

In the first two years, a diary and reassurance. Beyond that, or when PCOD is found, the first treatment is food and activity: less sugar and fried food, more activity, enough sleep. Even a small weight change often brings periods back. If not, cyclic progesterone tablets for a few months restart a rhythm. See PCOD and PCOS treatment in Chennai.

Heavy bleeding

Iron tablets to rebuild haemoglobin, plus tranexamic acid during periods to cut blood loss. Very heavy cycles are settled with hormone tablets and then regulated.

Period pain

Anti-inflammatory painkillers (mefenamic acid or ibuprofen) started at the first sign of pain work far better than paracetamol taken late.

Delayed puberty

Some girls are simply late developers and need only follow-up. Hormone causes are treated with low-dose hormone replacement. A blocked outflow (imperforate hymen) is corrected with a minor operation.

Discharge, hygiene and the HPV vaccine

Clear or white discharge without itching or smell is normal before periods start and around ovulation. Itching, curd-like discharge or a smell is usually a simple infection; see white discharge and vaginal infection treatment. Cotton underwear, water-only washing and changing pads every four to six hours prevent most problems. The HPV vaccine is recommended for all girls at 9 to 14, when two doses six months apart give full protection. The vaccine is given at the clinic; ask about it when you book. More on the gynaecological cancer screening and care in Chennai page.

Almost everything in adolescent gynaecology happens at the clinic: consultation, examination, scans, blood test requests, medicines and follow-up, at RV Clinic Madipakkam or RV Clinic Thalambur, whichever is closer. The rare procedure, such as surgery for a twisted ovarian cyst, is done by Dr. Ragavi herself at Unittas Multispeciality Hospital, which is 21 km from the Madipakkam clinic and 5 km from the Thalambur clinic. RV Clinic is an outpatient clinic. No operation is done at either clinic address. Thalambur's evening hours suit school timings.