Perspectives on pediatric and adolescent gynecology from the allied health care professional.

the healthiest outcome is achieved by early identifiTeens, Periods, and Pregnancy cation of the pregnancy. Assurances of confidentiality and access to pregnancy testing are key factors in Jeanne is 16 and has been coming to you for care promoting early entry of a pregnant teen into the since she was a toddler. Her younger siblings see you healthcare system. also. With the diagnosis of an intrauterine pregnancy, it Today’s appointment she made herself because is important to confirm gestational age, begin options she is having “some trouble with her periods.” Since counseling, and determine when and how she will menarche at age 12 she has had monthly periods but tell her parents. two months ago she had a one-day period and missed Jeanne’s history is consistent with her estimated her period this past month. She had sex once at a gestational age of pregnancy. Many teens, however, party after having a few drinks. She is afraid she for reasons of fear, denial, or ignorance, may give a might be pregnant and remembers that you told her history that suggests they are very early pregnant when she was about 12 that you would respect her when in reality they are further along. Their true confidentiality about sensitive issues. gestational age may limit their options for pregnancy Irregular periods are common in adolescence; termination. Also the pelvic exam is an opportunity many teens do not ovulate monthly for a year or two to do a Pap test and cultures for gonorrhea and chlaafter their menarche. However, pregnancy is the most mydia. Though the rates of gonorrhea and chlamydia likely cause of “irregular” periods in a teen. It is wise have declined, the incidence is highest in teens and to suspect or at least rule out pregnancy when a teen young adults. Abnormal Pap tests, often associated has some irregular periods, especially if: with the Human Papilloma virus, are frequent among sexually active teens. HIV counseling and testing • use of drugs/alcohol is suspected should be considered. • there is some instability in the teen’s family life Jeanne needs options counseling, as do all teens. such as parents’ divorce or separation, remarriage, A teen needs to hear the “what ifs.” What if you death, or parent has a new partner carried the pregnancy to term? What if you had an • poor intrafamily communication abortion? What if you placed the baby for adoption? • family abuse of drugs/alcohol The pros and cons of each choice and the likely and • family history of mental illness, especially in a potential effects on her life/academic career/family parent should be clearly identified. Include her partner if • domestic violence possible. A referral for options counseling may be made to Indeed, her pregnancy test is positive, her uterus is a local social service agency, which can be identified enlarged and she is clearly anxious about what to do through the yellow pages of the telephone book, on and how to tell her parents. Certainly the healthiest the Internet, or through the State Department of state for Jeanne is a non-pregnant state, and fortuPublic Health. Some schools have programs that innately the teen pregnancy rate has declined over the clude a teen counselor. past decade. Studies indicate a decrease in sexual Telling her parents is another issue that needs to activity in teens1 and increased use of condoms with be addressed. Can she tell her parents? Will she do first intercourse.2 However, once a pregnancy has been conceived so? What does she anticipate their reaction will be?