The method of evaluation and prediction of formation of menstrual function of adolescent girls

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Compared with other body systems, the human reproductive organs are the most sensitive to unstable ecological, economic, social, and adverse moral environments in society. It is well known that a deterioration of general and reproductive health in one generation can directly lead to a decrease in the health of future generations [5-8]. Considering this, children and adolescents are perhaps the most vulnerable groups in a population, and their health status has especially important social and medical implications [10, 11, 13].

Unfortunately, the current system of medical care for children does not provide the necessary level of prevention, diagnostics, treatment, and rehabilitation of reproductive system diseases. Despite a substantial modernization of the reproductive health service in recent years, there is still a clear and steady increase in the number of reproductive system diseases in adolescent girls [9, 12].

However, the timely identification of groups at a high risk of adverse developments in puberty and menstrual function can substantially help improve the probability of normal physical, sexual, and mental health and consequently the likelihood of a “healthy motherhood.”

Because of the importance of this issue, several authors have addressed the challenge of developing a set of risk factors that can lead to problems in the development of the reproductive system. Substantial effort has also been devoted to the creation of various prognosis algorithms and charts to assess the impact of various possible risks to the development of the reproductive system in girls [1-3]. In this study, an attempt is made to improve the methods that are currently used in this regard.

MATERIALS AND METHODS

In the course of preventive examinations of girls aged 9-11 years, it is possible to predict the upcoming formation of menstrual function using a method proposed by G.A. Ushakova (Kemerovo, 1993). Further development of this method was achieved by the works of S.I. Elgina [4]. In accordance with the resulting approach, the following issues can be predicted: (a) an early age of menarche; (b) a late age of menarche; (c) an excessively long period required to establish a normal rhythm of menstruation; (d) dysmenorrhea, and (e) abnormal uterine bleeding during the pubertalperiod.

To improve the predictive capability of this system, we propose several enhancements:

• Creation of a single comprehensive chart that includes complete information of all the risk factors.
• Identification of specific risk groups based on the main types of disorders of menstrual function.

Using this enhanced system, the most important preventive measures for adolescent girls can be determined and employed, depending on the type of menstrual function and the specific risk group involved.

The prognostic chart developed by this study includes the following factors: age, health, profession of the mother at the time of pregnancy and childbirth, course of pregnancy, place of birth and residence, and history of illnesses. Each factor has its own gradation expressed in a digital prognosis ratio. To determine the risk involved, it was necessary to analyze the statistical impact of these explanatory factors, and the calculated prognosis coefficients corresponding to these independent variables were then combined together with the resulting sum divided by the total weight index. Anexample of the prognosis chart, using the relevant coefficients for determining the early age of menarche, is presented in Table 1.

 

Table 1. Prognostic chart for the detection of the early age of menarche

Таблица 1. Прогностическая карта определения раннего возраста менархе

Early age of menarche
Factors	Factor grading	Prognostic coefficient (p)
Mother’s age	Up to 20 years 20-24 years 25-29 years 30-34 years ≥35 years	3.5 2.8 1.7 1.7 1.5
Mother’s occupation	Employee of enterprises with occupational hazards Employee of other enterprises Office employees Housewives	1.2 1.4 1.4 0.9
Mother’s health	Healthy Unhealthy	1.0 1.4
Course of pregnancy	Normal Complicated	2.1 11.5
Place of birth	City Village	1.5 1.1
Place of residence	Polluted Intermediate Relatively clean	2.9 1.2 2.1
Past medical history of the girl	No illnesses 1-2 illnesses >2 illnesses	1.6 1.1 2.5
Health of the girl	Healthy (health group 1) Functional abnormalities (health group 2) Controlled disease (health group 3)	1.2 1.5 1.8
Total weight index		15.3
Risk scale	Minimal risk	0.66-1.15
	Average risk	1.16-1.55
	High risk	1.56-1.95

 

To determine the degree of medical risk for any particular individual, the value obtained is analyzed using a Risk scale. If the predicted value lies in the minimum risk range, the girl is referred to be in the favorable prognosis group; if the predicted value is in the average risk range, the girl is referred to be in the “observance” group; if the predicted value is in the maximum range, the girl is referred to be in the unfavorable prognosis group.

The number of preventive measures considered appropriate depended on the predicted deviation from the normal course of establishing a healthy menstrual function, as well as the degree of risk. The main components of preventive monitoring consisted of examination by a gynecologist (on decreed or control dates), normalizing the regime of work and rest, diet, sanitizing sources of infection, use of sedative and vitamin therapy, adaptogens, psychological therapy, physiotherapy, and acupuncture.

RESULTS AND DISCUSSION

In total, 432 prognostic charts of girls aged 9-13 years 11 months were analyzed in this study. The average age of girls was 10.3 ± 0.9 years. Most girls (95.8%) were born in a megalopolis where they lived at the time of the examination, and 4.2% lived in rural areas. Only 20 patients (4.6%) lived in relatively environmentally clean areas of the city, and most of the examined patients lived in “intermediate” or “polluted” areas, with extensively developed highway networks and the presence of enterprises producing harmful environmental effects (81.5% and 13.9%).

The age of the mother at the time of the girl’s birth is shown in Figure 1.

 

Fig. 1. Age of the mother at the time of delivery

 

Thus, 30.1% of the girls were born when their mothers were aged 20-24 years, 19.9% when their mothers were aged 25-29 years, 18.5% when their mothers were aged 30-34 years, 18.1% when their mothers were aged >35 years, and 3.4% when their mothers were aged <20 years.

At the time of pregnancy and childbirth, 286 women (66.2%) were healthy and 146 (33.8%) had a certain somatic or gynecological pathology.

The mother’s place of work during pregnancy and childbirth was analyzed, and it was found that approximately half of the women (48.6%) were office employees (female students, doctors, teachers, etc.), and 20.8% of women did not work outside of their homes (housewives). The remaining women worked in industrial enterprises (24.1%), including those with harmful production factors (6.5%).

From a somatic medical history, it was revealed that 44.9% of girls had no illnesses, 39.4% had a history of 1-2 diseases, and 15.7% had more than two diseases. As a result, 62.9% of girls were assigned to health group 2, where there were different functional abnormalities, and 16.6% to health group 3 (chronic diseases in the stage of remission); 20.5% of girls were included in the health group 1.

In the course of this study, it was noted that a favorable outcome was generally observed at the time of the onset of menarche (Table 2).

 

Table 2. Degree of risk of deviations at the time of menarche onset

Таблица 2. Степень риска отклонений по времени наступления менархе

Risk scale	Early age of menarche		Late age of menarche
	N	%	N	%
Minimal	276	63.9	416	96.3
Average	140	32.4	14	3.2
Maximum	16	3.7	2	0.5
Total	432	100	432	100

 

Table 2 shows that for most of the girls, a timely onset of menarche was predicted. Only 3.7% (early onset of menarche) and 0.5% (late onset of menarche) were included in the group of unfavorable prognoses and required rehabilitative measures.

The greatest interest was generated from a prognosis of the main types of menstrual cycle disorders during puberty (Figure 2).

 

Fig. 2. Prognosis of menstrual disorders

 

The study revealed that more than half of the girls were in the middle risk group in all forms of menstrual function disorder and required regular monitoring by a gynecologist specialized in this age group. The majority (62.5%) of the girls were included in the “observance” group because of the development of abnormal uterine bleeding in the pubertal period (AUB PP). Approximately 41.3% of girls, who had a prognosis of prolonged establishment of normal rhythm of the menstrual cycle, were entered into the high-risk group and were provided with in-depth preventive measures. According to dysmenorrhea and AUB PP metrics, these figures were 18.1% and 12.9%, respectively.

CONCLUSION

The data obtained indicate the efficacy of using the proposed prognostic chart during preventive examinations of girls to identify the predictors of issues that might disrupt the establishment of a normal menstrual function, for subsequent monitoring of the groups identified as being at risk for various disorders, and appropriate implementation of preventive measures. The chart can be used not only by child and adolescent gynecologists but also by pediatricians, endocrinologists, and medical workers at schools. However, further research of a comparative study of the relative effectiveness of various preventive measures in girls in the risk groups for menstrual function disorders is required.

About the authors

Anna V. Mironova

St Petersburg State Pediatric Medical University

Author for correspondence.
Email: vladnyra@mail.ru

MD, PhD, Associate Professor, Department of Children Gynecology and Female Reproductology

Russian Federation, Saint Petersburg

Viktoria G. Balasanyan

St Petersburg State Pediatric Medical University

Email: v.g.balasanyan@mail.ru

MD, PhD, Dr Med Sci, Professor, Department of Children Gynecology and Female Reproductology

Saint Petersburg

References

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