Menstrual Cycle Cycle Disorders
RRM Academy Synopsis
Menstrual charts guide evaluation of teen PCOS and abnormal bleeding
A clinical review of teen PCOS and abnormal uterine bleeding finds that a menstrual chart works as a vital sign that may point to an underlying condition. The article presents the NaProTechnology approach, which looks for the root problem. PCOS is also named PMOS (Polyendocrine Metabolic Ovarian Syndrome).
Key Findings
- The American Academy of Pediatrics (2006), the American College of Obstetricians and Gynecologists (2015) and the New York Academy of Sciences (2008) published statements urging providers to teach patients to chart.
- PCOS is a diagnosis of exclusion, with at least nine other disorders to consider. The article reports an NIH recommendation to create a new name for PCOS while maintaining the Rotterdam criteria.
- The article reports that 30% of women with PCOS may have impaired glucose tolerance and 7% may have diabetes, and that 2% convert to diabetes per year.
- Abnormal uterine bleeding may show on the chart as brown bleeding, bleeding unassociated with menses, or a pattern that tends to stay the same day to day without a crescendo-decrescendo shape.
- The author concludes that charting guides laboratory and ultrasound evaluation and can be used to track progress after treatment starts.
Interpretation
The article is a clinical review of the menstrual cycle as a vital sign in adolescent medicine, with PCOS and abnormal uterine bleeding as its two examples. The author links society statements, cycle biology and the NaProTechnology steps of history, exam, chart review, targeted testing and treatment. The author notes that the effect of PCOS on cardiovascular events in older age remains to be determined.
RRM Context
Restorative reproductive medicine reads a menstrual irregularity as a sign of an underlying condition. The FertilityCare system in the article records bleeding, dryness and mucorrhea as biomarkers. This gives the clinician a record across cycles for NaProTechnology evaluation and treatment. The pediatric and gynecologic statements cited in the article support charting.
Abstract
The topic of how the menstrual cycle is a vital sign which could signal pathophysiologic process has received considerable attention in the past decade. The current recommendations of various academic groups will be discussed as well as the FertilityTMM Care method of charting and the Naprotechnology approach to evaluating abnormalities of the menstrual cycle. Two clinical scenarios seen in adolescent medicine, PCOS and AUB, will be analyzed looking at the pathophysiology of these clinical scenarios and their management. The approach will be one that conducts an evaluation to try to find the underlying problem and aims to restore the normal physiology of the menstrual cycle. The American Academy of Pediatrics, the American College of Obstetrics and Gynecology and the New York Academy of Sciences have published academic statements during the past ten years emphasizing the need for providers to teach patients how to chart and the important clinical ramifications of using this charting as a vital sign. In 2006 the American Academy of Pediatrics published in the Pediatrics Journal a recommendation titled: "Menstruation in Girls and Adolescents: Using the Menstrual Sign as a Vital Sign." In 2015, the American College of Obstetrics and Gynecology published a Committee Opinion emphasizing the need to teach women the charting of their menses and the important pathophysiologic process that could be detected with the charting.
