Beacon For Kids Gynaecology

• Most people will experience their first period by age 15. If you have not had your first period by 15, we call this primary amenorrhoea. If you have not had your first period by 15 (or if by age 13 you have no other signs of puberty such as breast development and pubic hair and no periods) you should see your doctor.
• Sometimes people have periods which then stop (secondary amenorrhoea). If you had periods and they stopped for 6 months you should see your doctor.
• There are many potential causes for absence of periods, some blood tests and sometimes an ultrasound scan (jelly on your tummy) can help to piece this together.

• Irregular periods are menstrual cycles that vary in length or are missed.
• Symptoms include periods that are shorter than 21 days or longer than 35 days or cycles varying by 9+ days.
• Periods are commonly irregular in the first couple of years after menarche (your first period) and for most people can become more regular with time as your hormones become more balanced.
• If irregular periods are accompanied by other symptoms such as acne, excess unwanted hair, thinning hair, pain or other changes in your body you should discuss these with your doctor.
• Irregular periods can also be caused by hormonal shifts (puberty), stress, extreme weight changes, PCOS, or thyroid issues or other hormonal conditions.

• Polycystic ovary syndrome(PCOS) is a common hormonal disorder during reproductive years.
• Symptoms may include irregular periods, heavy periods or no periods, excess body hair, acne, thinning hair.
• Approximately 1 in 10 young females have PCOS.
• The most common way to diagnose PCOS is by listening to your symptoms and taking some blood tests. These may show higher levels of some hormones such as testosterone.
• An ultrasound scan is not used to diagnose PCOS in adolescence as it is normal to have multiple follicles (PCOM) within 8 years of your first period. An ultrasound can however be used to rule out other conditions that can have similar symptoms to PCOS.
• It can be difficult to diagnose PCOS in teenage years as many of the symptoms of PCOS are also common in adolescents such as acne and irregular periods.
• Treatments used in PCOS depend on the most bothersome symptoms and the patient’s wishes/needs. They can include hormonal treatment options and/or metformin.

• It can be very common to have heavy periods as a teenager.
• Periods are when your womb (uterus) sheds it’s lining and this leads to blood coming out of the vagina.
• Often, in adolescence, anovulation is common (this is where the ovaries do not release an egg every month and this can lead to the lining of the uterus becoming thicker hence leading to heavier periods).
• If your periods are very heavy (or are heavy right from your first one), and you also experience easy bruising or excess bleeding from wounds, you may have a bleeding disorder and your doctor may recommend some bloods.
• It is helpful to keep a diary of your periods and bring it to your appointment to show the doctor.
• Possible treatment options available are medications to ease bleeding and or hormonal treatment options.

• Dysmenorrhea is when you experience painful abdominal cramps during your period.
• You may also experience lower back pain, radiating pain down your legs, nausea, vomiting and headaches alongside this pain.
• Your doctor may order scans such as an ultrasound (jelly on your tummy) to find out if there is an underlying condition leading to the painful cramping.
• Treatment may include hot compresses or warm showers, pain relief and or hormonal treatments to reduce or stop periods (in a safe way).

• Congenital gynaecological abnormalities are structural differences in development of the genital and or reproductive tract (hymen, vagina, cervix, womb and or tubes). They are typically present at birth (although may not be recognised until after puberty or even in adulthood).
• Sometimes these anomalies can cause painful periods, and/or absence of periods (typically primary amenorrhoea). They can also cause difficulty using tampons etc.
• They can be associated with differences in the development of the renal tract (kidneys and or bladder systems).
• If you or your doctor suspect you may have a difference in your genital/reproductive anatomy sometimes scans of your pelvis (ultrasound and or MRI scans) are advised. If you are found to have an anomaly of the reproductive tract a scan of your kidney system may be recommended.
• Treatments can include pain relief, hormonal treatment options and or procedures (surgery) depending on the anatomy and the patient’s wishes.

If you think your child may have labial fusion/adhesions, talk to your doctor.

• Labial fusion (or adhesions) is a condition in which the lips of the vaginal opening (labia) become stuck together down the middle, leaving either a small opening or no visible opening.
• It is common in girls under 7 years of age.
• The labia are usually separate at birth and for a couple of months after birth because the mother’s oestrogen (hormone) passes through the placenta to the baby. After 3-6 months these hormone levels get very low, which can cause the labia to stick together.
• Occasionally, urine can sit behind the fused labia and cause difficulty with toilet training, as there may be some dribbling after the child gets off the toilet. The urine may also spray. You might find it helps to sit your child on the toilet the wrong way around which opens the legs wider and may help the urine flow out.
• In most cases treatment is not necessary, and as the child gets older and starts to produce their own oestrogen the labia will separate.

• Lichen Sclerosus LS) is an inflammatory skin condition that can affect girls before puberty and after menopause.
• Skin lesions can occur anywhere on the body but are common on the genital area.
• Lichen Sclerosus can cause itching, soreness and bleeding. The itching and soreness can be very severe. The skin on the vulva can appear thin, pale in colour, or there may be areas of bruising, thickening of the skin, or breaking of the skin.
• Your doctor may prescribe you a steroid cream to treat this. They may also refer you to Dermatologist for additional input.
• You should also avoid using soaps, shower gels and bubble baths. Your doctor can advise you regarding moisturiser’s and a soap substitute. They may also advise a barrier cream to keep the surrounding skin healthy.

• Vulvovaginitis is a common condition effecting females between the ages of 2 and 7, before the start of puberty.
• It is inflammation of the vulva and or vagina.
• The main symptoms are vaginal discharge and soreness.
• The discharge can be white, green or yellow and can be smelly.
• Other symptoms may include redness of the vagina and vulval area, itching and pain when passing urine (commonly thought to be a urinary tract infection).
• Vulvovaginitis is commonly caused by bugs that are normal within this area of the body and occur frequently as young girls are toilet trained and or become responsible for their own hygiene.
• You should avoid using soaps, shower gels and bubble baths. Your doctor can advise you regarding moisturisers and a soap substitute. They may also advise a barrier cream to keep the surrounding skin healthy. It is important to ensure little girls wipe correctly (front to back) after they wee.

• A cyst is a pocket of fluid that can develop on an ovary either as part of the way the ovary normally works (functional), or not (non-functional). They can vary in size hugely from 3cm to the size of a large melon.
• Cysts are very common. PCOS does not cause cysts.
• Most cysts go un-noticed or are found during a scan for something else, but they can occasionally cause pain, frequent urination or issues with periods.
• Cyst treatment depends on your symptoms, the size of the cyst and the type of cyst. Most cyst will go away by themselves, but some cysts may need to be removed, this is usually during a surgery.
• Sometimes cysts can twist on themselves (torsion) and cut off the blood supply to the ovary. Usually this would cause severe pain and or vomiting. If you experience these symptoms, you should attend your local emergency department.
• If you have symptoms of a cyst, or a cyst was identified during a scan for something else, you should see your doctor.

• Your doctor may decide that he or she would like you to go for an ultrasound of your pelvis.
• A pelvic ultrasound is a non-invasive, diagnostic imaging procedure to visualize structures in the lower abdomen, including the uterus (womb), ovaries and other pelvic structures.
• This allows your doctor to have a better look at what is going on inside your uterus and reproductive organs.
• This will involve you going to a radiology department and meeting a person called a sonographer.
• They will put some jelly on your lower stomach and use their camera to scan your stomach.
• They can take some pictures while doing this and send them back to your doctor to help them get a better understanding of what might be going on.