Adolescent girls’ periods and first appointments

What symptoms and history should I describe?

Keep a simple record of dates, pain and bleeding rather than asking a teenager to label the problem as a hormonal disease. Note school absence, interrupted sleep, leaks, dizziness and how long each episode lasts. The effect on daily life helps explain why advice is needed.

Families can prepare a calm explanation of what will happen at an appointment and invite the young person’s own questions. Discuss who will be present and how private conversations are handled. Mention the patient’s age when booking to confirm that the appointment is appropriate.

Guidance: NHS: Starting periods · NHS: Heavy periods · International PCOS guideline: adolescent recommendations

How is the problem assessed?

The clinician may ask about growth, nutrition, exercise, medicines, family history and the pattern of periods. Heavy flow, prolonged gaps, severe pain or concerns about pubertal development may need further assessment. A scan is not automatically the first or only step.

PCOS assessment in adolescents differs from adult assessment. Irregular cycles alone or an ultrasound appearance should not be used as a self-diagnosis. A clinician considers development, time since menarche, signs of androgen excess and other possible causes.

Guidance: NHS: Starting periods · NHS: Heavy periods · International PCOS guideline: adolescent recommendations

What treatment and follow-up might be discussed?

A first consultation can explain the pattern, identify tests that would help and arrange referral where needed. The aim is to make the next step understandable to the young person as well as the family. Ask how follow-up will be arranged if the cycle pattern remains uncertain.

Pain or heavy bleeding that interferes with school deserves a practical plan. Ask what symptom relief is safe for the patient’s age and medical history and which changes should prompt a review. Avoid prescribing adult hormonal treatments through family advice or online recommendations.

Before the visit, bring dates, relevant reports and a medicine list. It is reasonable to write down concerns about pads, exercise, school or privacy. An examination should be explained beforehand; the clinician chooses it according to the actual concern and the young person’s circumstances.

Guidance: NHS: Starting periods · NHS: Heavy periods · International PCOS guideline: adolescent recommendations

Questions to ask at the appointment

• Is this pattern expected for the time since her first period?
• Could heavy bleeding or fatigue need a blood count?
• What support is appropriate for pain affecting school?
• Should paediatric, adolescent-health or gynaecology review be arranged?

Take a short written list and begin with your most important concern. If a test or treatment is recommended, ask what decision it will help make and how the result will be communicated. Bring the plan back at follow-up so you can discuss what improved and what remains unresolved.