This document discusses adolescent gynecology issues including abnormal menstruation such as precocious puberty or delayed menarche, pathology associated with low estrogen states, and genital trauma including sexual abuse. Precocious puberty is defined as breast and pubic hair growth before age 8 or menstruation before age 10, which can be caused by premature gonadotropin release from the anterior pituitary or feminizing ovarian tumors. Treatment depends on the underlying cause and may involve GnRH analogs, surgery, or treating an intracranial lesion. Pathology from hypoestrogenism can cause labial adhesions.

1. Adolescent Gynecology
DR NAZIMAH IDRIS
Obstetrician & Gynecologist
Hospital Alor Star

2. ISSUES
• Abnormal menstruation
• Pathology associated with low estrogen
state
• Genital trauma including sexual abuse
• Ovarian tumours

3. Abnormal menstruation
• Precocious puberty
• Delayed menarche
• Dysfunctional uterine bleeding

4. Precocious puberty
• Breast and pubic hair growth before the age
of 8 years, menstruation before the age of
10 years.
• Cause: Premature release of gonadotrophins
from anterior pituitary:
- constitutional
- intracranial lesion

5. • Other cause: feminizing tumour of the
ovary – landmarks of puberty does not
appear in usual order, vaginal bleeding is
out of proportion to breast development

6. Treatment
• Treat the cause.
• Gonadotrophin release – GnRH analog
• Intracranial lesion – GnRH analog or
surgery
• Ovarian tumour - surgery

7. Pathology associated with
hypoestrogenism
• Labial adhesions