Menarche

CF patients often experience delayed puberty. In females, menarche occurs 18 months later than average, and menstrual irregularity is common. Females also have reduced fertility due to increased viscosity of cervical mucus. Due to increasing life expectancy, pregnancy is becoming more common however, outcomes depend on pre-partum nutritional and pulmonary status. 

TP, a 22 year-old woman, presents to your office for a routine gynecologic examination. She entered menarche at the age of 12. Her last menstrual period was 3 months ago. Her periods are often irregular and occur about every 2 to 3 months. She has had all normal Pap smears in the past and no history of sexually transmitted infections. She is currently in a monogamous relationship with a male partner. She has had a total of four sexual partners. She is not taking oral contraceptives and does not routinely use condoms. She has never been pregnant in the past, but she plans on starting a family in the near future. As you examine the patient, you note facial and chest acne, increased facial and abdominal hair, and obesity. 

Therapeutic modalities for amenorrhea are targeted at restoring the normal menstrual cycle. The goals of treatment are to preserve bone density, prevent bone loss, and restore ovulation, thus improving fertility as desired. Amenorrhea resulting from conditions contributing to hypoestrogenism also may affect quality of life via the induction of hot flashes (premature ovarian failure), dyspareunia, and in prepubertal females, lack of secondary sexual characteristics and absence of menarche. 

Estrogen enhances Candida adherence to vaginal epithelial cells and yeast-mycelial transformation this is supported by the fact that infection rates are lower before menarche and after menopause (except in women taking hormone replacement therapy), while rates are higher during pregnancy... 

A number of endocrine factors have been linked to the incidence of breast cancer.5,6 Many of these relate to the total duration of menstrual life. Early menarche (prior to age 12) and late menopause (after age 55) increase a women s breast cancer risk. Similarly, investigators have reported that bilateral oophorectomy prior to age 35 reduces the relative risk of developing breast cancer. Nulliparity and a late age at first birth (greater than or equal to 30 years) have been reported to increase the lifetime risk of developing breast cancer twofold. 

Although it is not clearly defined, hormones and reproductive history are associated with the risk of developing ovarian cancer. Nulliparity, infertility, early menarche, and late menopause are associated with an increased risk of ovarian cancer. -7... 

Menarche The onset of menstrual periods, usually occurring between the ages of 10 and 17. 

Goldberg, S., Blumberg, S. L., Kriger, A. (1982). Menarche and interest in infants Biological and social influences. Child Development, 53, 1554—1560. 

Breast r Early menarche Postmenopausal obesity 1 Steroid hormones... 

Billewicz, W. Z., Fellowes, H. M., and Thomson, A. M. (1981). Menarche in Newcastle upon lyne, England, UK, girls. Annals ofHuman Biology 8,313-320. 

Acne vulgaris (Ortho Tri-Cyclen and Estrostep only) For the treatment of moderate acne vulgaris in females 15 years of age or older who have no known contraindications to oral contraceptive therapy, desire contraception, have achieved menarche, and are unresponsive to topical antiacne medications. 

Children Safety and efficacy are expected to be the same for postpubertal adolescents up to 16 years of age. Use of this product before menarche is not indicated. 

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