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    Menstruation: The sixth vital sign

    Menstrual cycle changes can be as useful predicting potential health problems as an abnormal blood pressure, heart rate, or respiratory rate, according to a new study that advocates evaluating menses as a vital sign.

    “It is important for clinicians to have an understanding of what is considered normal and abnormal menstruation in adolescents and know how to evaluate this patient population,” says Xiomara Santos, OB/GYN, a physician and assistant professor of obstetrics and gynecology at Texas Children’s Hospital who served on the committee reponsible for the recommenation. “Identification of abnormal menstrual patterns in adolescence may improve early identification of potential health concerns for adulthood.”

    The new report was crafted by the American College of Obstetricians and Gynecologists’ (ACOG) Committee on Adolescent Care, and emphasizes the evaluation of adolescent menstrual patterns at each preventive care visit. It updates an earlier report with a similar message.

    More: A link between sugary drinks and earlier menarche?

    “Clinicians should educate girls and their caretakers about what to expect of the first menses and the range for normal cycle length of subsequent menses. Once adolescent girls begin menstruating, clinicians should ask at every visit for the patient’s first day of her last menstrual period and the pattern of her menses,” she says. “By including this information with the other vital signs, clinicians emphasize the important role of menstrual patterns in reflecting overall health status.”

    The median age of menarche is between 12 and 13 years of age, but can be impacted by environmental factors including socioeconomic status, nutrition, and access to healthcare, according to the report. Knowing what to expect can help with early identification of abnormal patterns that could signal other health problems.

    Clinicians, too, must become well-versed in variations in menstrual patterns, the committee notes.

    It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient,” according to the guidance. “By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers.”

    One of the hurdles to assessing menstrual patterns and abnormalities is the hesitance of adolescent girls to discuss menstruation with their parents or caretakers. Sometimes, they may be more comfortable turning to another trusted adult, such as their pediatrician, for information of cycle patterns and menstrual flow.

    Clinicians must be able to relay accurate information about normal ranges for menstrual cycle length and the amount of bleeding that is typical during adolescence, but this does not always happen, according to the report. The guidance outlines what is normal, and some of the conditions abnormal cycles may indicate.

    NEXT: The difficulty of identifying normal menses in adolescents 

    Rachael Zimlich, RN
    Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare ...

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    • VeronicaSokei
      I believe the standard is 6th vital sign is PAIN and maybe we should make the 7th vital sign MENSES. Thoughts?

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