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Darcie M. Takemoto, DO, is a Pediatric Resident, Texas A & M Health Science Center, Department of Pediatrics, McLane Children's Scott & White. Meera S. Beharry, MD, FAAP, is an Assistant Professor of Pediatrics, Texas A & M Health Science Center, Adolescent Medicine Section Chief, Department of Pediatrics, McLane Children's Scott & White.
Disclosure: The authors have no relevant financial relationships to disclose.
Menarche is a sentinel event in a young woman's life. Some young women see this as a positive event, whereas many others view it negatively. 1,2 In her book Women's Bodies, Women's Wisdom , Dr. Christiane Northrup 1 invites the reader to envision a culture in which menarche is viewed positively and celebrated; one in which subsequent menstrual cycles are a chance to become in tune with one's creative energies, along with time for reflection and rest. 3
The biologic and social significance of menses can only be ascertained through a detailed history. For many young women, their sources of information about reproductive health care are not reliable. Others may believe that pathologic symptoms are "normal" because other women in their family have them. Providers can help demystify menses and prevent future health problems through accurate assessment of menstrual function. 4
Elements of History
The American Academy of Pediatrics has recommended using menstruation as an additional vital sign. 4 The following elements of history help establish if patterns are normal or not: age at menarche; frequency of menses; duration of menses; quality of flow; and any associated symptoms. Asking about "the first day of the last menstrual period" is important not only for assessment of menstrual problems, but also for helping a young woman get in the habit of answering this question throughout her reproductive life. Other helpful questions are discussed below and are listed in Table 1 .
Age
Menarche signals the end of puberty and the beginning of reproductive ability. It occurs between Sexual Maturity Rating 4 and 5 for both development of breasts and pubic hair and after the growth spurt ( Figure 1 ). 5 Menstrual bleeding that occurs without expected accompanying pubertal changes should prompt further evaluation for endocrine abnormalities, infection, trauma, or abuse.
According to data from the third National Health and Nutrition Examination Survey (NHANES...