Objectives Paediatric and Adolescent Gynaecology is a diverse subspecialty of gynaecology, covering important issues for adolescents, including menstrual disorders and contraception. The primary objective of this study is to establish the most common reasons for adolescent presentation to a specialist paediatric gynaecology outpatient clinic as well as to understand the symptoms associated with menstruation that cause adolescents to present to secondary care services.
Methods A retrospective study was conducted using electronic documents and outpatient clinic letters to establish patient demographics, clinical details, investigations undertaken and management. The records of 595 patients who attended the Paediatric Gynaecology Clinic at the University Hospital of North Midlands (UHNM) across a 5 year period between July 2016 to June 2021 were analysed. Cases were analysed by age, presentation, investigations undertaken, diagnosis and any management required. Those with incomplete medical records were excluded from the analysis. Details from any follow-up appointments within the 5-year window were included within the clinical picture. Patients aged over 10 years old were considered adolescents within this analysis, to align with World Health Organisation (WHO) definitions.
Results Across the 595 patients included in the analysis, 433 (72.8%) were considered adolescent (≥10 years old). Across the adolescent population, there were 31 different reasons for presentation. The three most common reasons were menstrual disorders (44.6%), secondary amenorrhoea (9.0%) and abdominal pain (8.5%). Regarding menstrual disorders, the most common reason for presentation was heavy menstrual bleeding, affecting 64% of those presenting with menstrual symptoms and 29% of the total adolescents who presented to the clinic. Other concerns, such as oligomenorrhoea and dysmenorrhoea, affected 45% and 31% of those presenting with menstrual symptoms respectively. In total, heavy menstrual bleeding accounted for 20% of the total caseload of the paediatric gynaecology clinic across the 5 years analysed.
Conclusions The Paediatric Gynaecology Clinic at UHNM sees a wide variety of reasons for presentation, covering physical symptoms as well as psychological and social issues. Adolescents are the predominant users of this service and the reasons for them to present to the clinic are vastly different than the pre-adolescent age group, with demand indicating there could be a need for a specialist adolescent gynaecology clinic. Menstrual disorders were the most common worry for adolescent patients, with heavy menstrual bleeding being the predominant concern and a common reason for a referral from primary care to specialist paediatric gynaecology services. Due to the variety and uniqueness of presentations to the paediatric gynaecology clinic, there is a need for both paediatric and gynaecological input for the management of adolescent patients.
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