Title: Reproductive Morbidity and Endocrinological Profile of Unmarried Adolescent Girls (16-18 years) in Urban Setting

Authors: Nirmala.C, Jayakumari.C, Mayadevi.B, Nandini V.R

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i3.141

Abstract

Background: Adolescence, defined by WHOM as period between 10-19 years, represents an unique period of life cyle. In India every 5th person is adolescent. Adolescent girls are in a crucial stage of their life cycle and their health can impact the health of future generations. so it is important to assess burden of morbidity among adolescents.

Objectives: To study the reproductive morbidity of unmarried Adolescent girls (16-18 years.) also to study the endocrinological profile of unmarried Adolescent girls (16-18 years).

Methods: This cross-sectional study was done among higher secondary schools of Thiruvananthapuram Corporation area, which is the capital city of the State of Kerala in South India. A structured questionnaire was administered to 360adolescent girls, aged 16-18years, to assess reproductive morbidity. General  physical examination and blood tests were done to assess endocrinological profile.

Results: (55.1) belonged to 16 years, 154 (42.8) belonged to 17 years and 8 (2%) to 18 years.  The mean age of menarche was 12.69 years).Majority79.4% belonged to middle class, 17.2% belonged to lower class, and 3.4% to upper class. High prevalence of underweight ie 146 girls (33%) had under weight and 2% had obesity. Clinically pallor was seen among122 girls (34%).diffuse thyroid enlargement was noted for 27 (5.4%). 185(37.5%) had acne and 50 (10%) showed hyperpigmentation. Hirsuitism was found in 32 (6.4%) girls. 61.1% of girls reported gynaecological morbidity. Major problem was dysmenorrhoea and 61.1% of girls reported having dysmenorrhoea.  Irregular cycles were reported by 11.1% of girls.  Abnormal uterine bleeding was reported by126 (45.3%) commonest symptom was Oligomenorrhoea reported by 96 (26.7%). heavy menstrual bleeding was reported by16(4.4%).irregular cycles were reported by 11.8% of girls 18.8 of girls reported vaginal discharge. 14.4 % had itching and vaginal discharge. Regarding endocrinological  problems, Thyroid enlargement was detected in 27 (7.5%) out of which 23(6.3% )were diagnosed to have hypothyroidism. PCOS was seen in 13(3.6% ) out of which 12 were obese PCOS.

Conclusion: Based on our study we conclude that a high proportion of unmarried adolescent girls suffer reproductive morbidity and Endocrinological morbidity which are associated with long term consequences. There is an urgent need to restructure reproductive and sexual health care programme of adolescents with main focus on primary prevention measures.

Keywords: Adolescents, Reproductive Morbidity, Endocrinological morbidity, PCOS hypothyroidism.

References

1.      WHO Health needs of adolescents. Report of WHO Expert Committee, Technical Report series, 609:15.

2.      Ministry of health and Family welfare, Government of India,. ‘Implementation Guide,Reproductive child health-II GOI 2006

3.      RKSK – rashtriya Kishore Swasthya Karyakram - Government of India 2014

4.      American Academy of Pediatrics Comm-ittee on Adolescence; American College of Obstetricians and Gynecologists Comm-ittee on Adolescent Health Care; Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118 (5):2245-2250.

5.      Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):383-390.

6.      World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World Health Organization Task Force on Adolescent Reproductive Health. J Adolesc Health Care. 1986;7(4):236-244.

7.      Flug D, Largo RH, Prader A. Menstrual patterns in adolescent Swiss girls: a longitudinal study. Ann Hum Biol. 1984;11(6):495-508.

8.      Metcalf MG, Skidmore DS, Lowry GF, Mackenzie JA. Incidence of ovulation in the years after the menarche. J Endocrinol. 1983;97(2):213-219.

9.      James AH. Bleeding disorders in adolescents. Obstet Gynecol Clin North Am. 2009;36(1):153-162.

10.  Nichols WL, Rick ME, Ortel TL, et al. Clinical and laboratory diagnosis of von Willebrand disease: a synopsis of the 2008 NHLBI/NIH guidelines. Am J Hematol. 2009;84(6):366-370.

11.  Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003;9:505-514.

12.  Goodman NF, Bledsoe MB, Cobin RH, et al. American Association of Clinical Endocrinologists medical guidelines for the clinical practice for the diagnosis and treatment of hyperandrogenic disorders. Endocr Pract. 2001;7:120-134.

13.  Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98:4565-4592. 40

14.  Hickey M, Doherty DA, Atkinson H, et al. Clinical, ultrasound and biochemical features of polycystic ovary syndrome in adolescents: implications for diagnosis. Hum Reprod. 2011;26:1469-1477. 43.

15.  Singh J, Singh JV, Srivastava AK, Suryakant. Health status of adolescent girls in slums of Lucknow. Indian J Community Med 2006;31:102–3.

16.  Jogdand K, Yerpude P. A community based study on menstrual hygiene among adolescent girls. Indian J Maternal Child Health 2011;13:3–6.

Corresponding Author

Nirmala.C

Professor and Head, Department of Obsetrics and Gynaecology

Sree Avittom  Thirunal Hospital, Govt. Medical College, Trivandrum