Adolescent medicine, based on the physiological processes of puberty and general maturation, has ... more Adolescent medicine, based on the physiological processes of puberty and general maturation, has developed dramatically over the past few decades. The population of persons in the period of puberty and adolescence has been identified as a healthy population, but one at relatively high risk. This is one of the most dramatic and fascinating periods of human life, when processes of physical, mental, and social maturation take place. During female puberty and adolescence, the hypothalam-pituitary-ovarian (HPO) axis matures, resulting ultimately in the capacity for full reproductive potential.14 These processes are gradual, however, and it may take up to five gynecological years for regular ovulatory cycles to get es tab l i~hed .~~ Menstrual dysfunction and anovulatory cycles are very common, in particular during the first two years after menarche,&l2 and in most instances are short lived. In some young women, however, these may be early manifestations of persistent menstrual disorder; hence, the importance of detecting in adolescence conditions that may progressively lead into reproductive disorders. During the process of maturation, not everyhng goes smoothly, and certain conditions, like acne, hirsutism, menstrual irregularities and polycystic ovary syndrome can occur. In fact such conditions usually have their onset in adolescence, but may influence the entire adult life of a For these reasons, in recent years there has been an increased interest in diagnosing polycystic ovarian syndrome (PCOS) in ad~lescents. '~.~~ Many women with PCOS have menstrual disturbances that begin in adolescence. Also, the menstrual irregularities, hir~utism,'~ and acne associated with PCOS may be a source of significant concern for the adolescent female since body image and self esteem are important factors that affect social interaction within peer groups.
Clinically significant PMS is experienced infrequently by young girls and adolescents. It becomes... more Clinically significant PMS is experienced infrequently by young girls and adolescents. It becomes more prevalent as women get older and is reported in up to 40 per cent of older women. To date, the etiology and underlying pathophysiologic mechanisms leading to symptoms of PMS have not been identified. Although multiple treatments are utilized, randomized double-blind crossover studies have failed to confirm the benefit of any one regimen. Most adolescents should be managed with reassurance and dietary and exercise modifications rather than with medication.
Journal of Pediatric and Adolescent Gynecology, Aug 1, 1996
ABSTRACT Background Sexually transmitted diseases (STDs) are epidemic among adolescents. Girls su... more ABSTRACT Background Sexually transmitted diseases (STDs) are epidemic among adolescents. Girls suffer more serious health consequences than boys yet they are often inadequately treated. Many girls with pelvic inflammatory disease (PID) are initially evaluated in Pediatric Emergency Departments. The Centers for Disease Control (CDC) recommend hospital admission for adolescents with PID, a leading cause of infertility, reflecting the need for aggressive management in these patients. This study surveyed physician members of the Section on Pediatric Emergency Medicine of the American Academy of Pediatrics by telephone and mail to determine attitudes and practices related to the management of PID in adolescent girls. Methods Of a total membership of 501, 96 pediatricians were randomly selected and 54 (56%) completed the survey (78% by telephone & 22% by follow up mail questionnaire); most (95%) had teaching responsibilities and were fellowship trained (61%). Geographic distribution included: East 33%;South 24%; Midwest 28%; West 15%. All saw patients up to age 18 years and 31% saw patients to age 21; most (70%) worked in an urban setting and estimated that the large majority of their patients were from poor minority groups. Results 51 (94%) had diagnosed PID within the past 2 years and 37 (69%) diagnosed PID, on average, once a month or more. Nearly two thirds of physicians surveyed indicated that they thought that the care of an adolescent with an STD should be different from that of an adult and that this age group was more prone to medical complications. However, the majority, 28 (52%), did not routinely admit girls with PID. Among those treating on an outpatient basis, just over half arrange follow up within 72 hours of initial treatment as recommended in CDC guidelines for adults, and most do this by providing a phone number. While most emergency physicians routinely suggest condom use (87%) and HN testing (63%) after diagnosing an STD, a minority routinely provide contraceptive counseling (43%) or partner notification (32%). Conclusions The results of this survey suggest that pediatric emergency department physicians frequently diagnose PID in adolescent girls yet many do not follow CDC management guidelines for inpatient admi and provide less than optimal counseling for high risk adolescents. Physician education regarding CDC guidelines and an appreciation of the concerns which lead to their formulation may improve the care of adolescent girls with PID.
American Academy of Pediatrics eBooks, Jul 4, 2005
ABSTRACT Menstrual bleeding that falls outside the range of normal in adolescents is often a caus... more ABSTRACT Menstrual bleeding that falls outside the range of normal in adolescents is often a cause of great concern for both girls and their families. Often, much of this anxiety can be alleviated with proper anticipatory guidance about menarche and early menstrual bleeding patterns. Eliciting a menstrual history from an adolescent girl is challenging, and the use of concrete methods to chart their patterns and flow, such as menstrual calendars and pictorial bleeding assessment calendar (PBAC) tools, may be helpful. The importance of obtaining a confidential history from the adolescent girl cannot be overestimated. A confidential sexual history is essential so that pregnancy and infectious causes of bleeding are addressed. Not all menstrual bleeding in young girls is attributable to immaturity of the HPO axis. Anovulation and DUB from other clinically relevant conditions in adolescent girls must also be considered. Chief among these is PCOS, which should always be ruled out when a girl presents with excessive bleeding associated with clinical signs of hyperandrogenism, obesity, or insulin resistance. Attention must also be paid to signs or a family history of a bleeding disorder, as vWD is commonly associated with excessive uterine bleeding. Importantly, the laboratory testing for both PCOS and vWD is affected by therapies for the excessive bleeding, and it should be performed before hormonal interventions or blood products are administered or during the placebo phase if treatment has begun. Management goals for excessive uterine bleeding include stabilizing the endometrium and stopping further blood loss, as well as preventing future uncontrolled blood loss. Hormonal stabilization of the endometrium is often helpful regardless of the cause of bleeding and especially in those with hormonally mediated anovulation. New antifibrinolytics, such as tranexamic acid, may also be helpful in the emergent setting and in adolescents with bleeding disorders.
Journal of Pediatric and Adolescent Gynecology, Dec 1, 2020
Study ObjectiveWe aimed to describe fertility desires in healthy adolescent females and to explor... more Study ObjectiveWe aimed to describe fertility desires in healthy adolescent females and to explore associations of fertility desire with conditions and therapies potentially compromising fertility.DesignThis was a cross-sectional, anonymous survey.Setting and ParticipantsA total of 323 female adolescents aged 13-19 years were recruited from clinic waiting areas at a children's hospital. We oversampled on days when clinics serving adolescents with potential fertility compromise were scheduled.Main Outcome MeasuresWe measured fertility desire by agreement with the statement “I want to have children someday.” To measure compromised fertility we asked “In the past year, has a doctor, nurse or other medical professional ever talked to you about the possibility that you may have decreased fertility and may not be able to have your own biological child someday?” To measure depression severity, we used a validated scale, the PHQ-9, scores were dichotomized into no/mild and moderate/severe depression.ResultsMean age was 16.06 ± 1.87 years. Of the 323 participants, 57% identified as Hispanic, 24% as Black, 93.5% as cisgender, 6.5% as transgender/gender diverse, 70% as heterosexual, and 30% as sexual minority. A total of 35% had moderate/severe depression, and 12% had compromised fertility. Overall, 89% wanted children. Fewer transgender/gender diverse than cisgender participants wanted children (67% vs 93%, P < .001), as did fewer with moderate/severe versus no/mild depression (83% vs 93%, P < .05), whereas those with compromised fertility versus those without and heterosexual versus sexual minority participants had similar fertility desires. Transgender/gender diverse identity (odds ratio, 0.33; 95% confidence interval, 0.11-0.97; P < .05) and moderate/severe depression (odds ratio, 0.45; 95% confidence interval, 0.22-0.93; P < .05) were independently associated with lower fertility desire.ConclusionsWe found a high overall proportion of female adolescents desiring future children, and only 2 independent predictors of decreased fertility desire, namely, transgender/gender diverse identity and moderate/severe depression.
Journal of Pediatric and Adolescent Gynecology, Dec 1, 2021
OBJECTIVES To compare body mass index (BMI) changes in adolescents using long-acting reversible c... more OBJECTIVES To compare body mass index (BMI) changes in adolescents using long-acting reversible contraceptives (LARCs), etonogestrel subdermal implant (ENG-implant), levonorgestrel intrauterine device (LNG-IUD) and copper IUD (Cu-IUD) by initial BMI category from time of LARC insertion to within 6-18 months after insertion. DESIGN Single-center retrospective cohort study. SETTING & PARTICIPANTS We reviewed electronic health records from our large health system to identify and follow a cohort of 196 adolescents aged 14-19 years with LARCs inserted from 2010 to 2016. We excluded adolescents with conditions or medications affecting weight, including childbirth. MAIN OUTCOME MEASURE BMI change from LARC insertion to first BMI documented after 6-18 months. RESULTS Mean age was 17.2±0.2 years; 59% Hispanic, 29% Black; mean BMI 26.4±7.1 kg/m2; 51% underweight/normal; 24% overweight; 25% obese. Mean time to first BMI documented after LARC insertion was 10.1±3.2 months. Mean BMI change for the total cohort was +0.73±1.8 kg/m2 indicating weight gain. Mean BMI change for ENG-implant + LNG-IUD users (N=127) was larger than for Cu-IUD users (N=69) [+0.92±1.9 kg/m2 vs. +0.37±1.6 kg/m2, respectively, p<.05]. Two-way ANOVA showed both initial BMI category (p=.001) and type of LARC (p=.011) had an independent significant main effect on BMI change. A significant interaction effect (p=.017) showed that obese adolescents had a larger increase in BMI when they were using a progestin-releasing LARC as compared to a Cu-IUD (p<.05). CONCLUSION Adolescents using progestin-releasing LARCs, have a larger increase in BMI within 6-18 months after device insertion than those using Cu-IUDs. The disproportionate increase in BMI with progestin-releasing LARCs is primarily contributed by obese users.
The Early Adolescent Girl: Ages 10-13 The Middle Adolescent Girl: Ages 14 - 17 The Young Adult Wo... more The Early Adolescent Girl: Ages 10-13 The Middle Adolescent Girl: Ages 14 - 17 The Young Adult Women: Ages 18-22 The Female Body Image Physchosexual Development Negotiating Confidentiality The Mother-Daughter-Female Clinician Triad Issues for Male Clinicians Ethical and Legal Issues The Health Maintenance Visit The Preparticipation Sports Physical Reproductive Health for Girls with Chronic Illness Contraceptive Counselling and Prescription Overweight, Underweight and Dieting Depression and Suicide Tobacco, Alcohol and other Drugs Breast Disorders Common Dermatological Problems Abdominal Pain Menstrual Dysfunction Disorders of Vulva, Vagina and Cervix Genital Human Papillomavirus Infection in Adolescents Management of Adolescent Pregnancy Abortion Lesbian Adolescents Sexual Assault, Rape and Sexual Abuse
Journal of Pediatric and Adolescent Gynecology, Aug 1, 1997
To explore the attitudes of inner-city minority female adolescents toward medical and surgical ab... more To explore the attitudes of inner-city minority female adolescents toward medical and surgical abortion to determine if medical abortion methods, which have been shown to be both effective and safe, might have greater appeal than surgical abortion. A cross-sectional, self-administered survey. The waiting room of an inner-city hospital-based adolescent clinic. At total of 157 female adolescents aged 13 to 21 years; Hispanic (56%) and African American (31%). Most (94%) were sexually active, 43% had been pregnant, and 29% had previously had a surgical abortion. An 86-item questionnaire examining attitudes toward medical and surgical abortion safety and impact on future fertility, and pregnancy, abortion, and sexual history. A total of 68% believe that abortion is safe, and 55% believe that having an abortion is better than having an unwanted child. Belief in the safety of abortion was significantly associated with older age and with never having had an abortion. Almost three fourths (72%) believe that having an abortion might impair future fertility either from surgical damage (73%) or &quot;as a punishment for having an abortion&quot; (38%). The majority (72%) believe that &quot;the more abortions you have, the harder it will be to get pregnant in the future.&quot; Regardless of personal abortion experience, 51% believe that a medical abortion would be safer than a surgical abortion. A minority (34%) believe that it would be easier to get pregnant after a medical abortion than after a surgical one. Although most inner-city, minority adolescents believe that abortion is safe, they also believe they risk their future fertility by having an abortion. The availability of medical abortion regimens would greatly influence decisions regarding abortion.
Adolescent medicine, based on the physiological processes of puberty and general maturation, has ... more Adolescent medicine, based on the physiological processes of puberty and general maturation, has developed dramatically over the past few decades. The population of persons in the period of puberty and adolescence has been identified as a healthy population, but one at relatively high risk. This is one of the most dramatic and fascinating periods of human life, when processes of physical, mental, and social maturation take place. During female puberty and adolescence, the hypothalam-pituitary-ovarian (HPO) axis matures, resulting ultimately in the capacity for full reproductive potential.14 These processes are gradual, however, and it may take up to five gynecological years for regular ovulatory cycles to get es tab l i~hed .~~ Menstrual dysfunction and anovulatory cycles are very common, in particular during the first two years after menarche,&l2 and in most instances are short lived. In some young women, however, these may be early manifestations of persistent menstrual disorder; hence, the importance of detecting in adolescence conditions that may progressively lead into reproductive disorders. During the process of maturation, not everyhng goes smoothly, and certain conditions, like acne, hirsutism, menstrual irregularities and polycystic ovary syndrome can occur. In fact such conditions usually have their onset in adolescence, but may influence the entire adult life of a For these reasons, in recent years there has been an increased interest in diagnosing polycystic ovarian syndrome (PCOS) in ad~lescents. '~.~~ Many women with PCOS have menstrual disturbances that begin in adolescence. Also, the menstrual irregularities, hir~utism,'~ and acne associated with PCOS may be a source of significant concern for the adolescent female since body image and self esteem are important factors that affect social interaction within peer groups.
Clinically significant PMS is experienced infrequently by young girls and adolescents. It becomes... more Clinically significant PMS is experienced infrequently by young girls and adolescents. It becomes more prevalent as women get older and is reported in up to 40 per cent of older women. To date, the etiology and underlying pathophysiologic mechanisms leading to symptoms of PMS have not been identified. Although multiple treatments are utilized, randomized double-blind crossover studies have failed to confirm the benefit of any one regimen. Most adolescents should be managed with reassurance and dietary and exercise modifications rather than with medication.
Journal of Pediatric and Adolescent Gynecology, Aug 1, 1996
ABSTRACT Background Sexually transmitted diseases (STDs) are epidemic among adolescents. Girls su... more ABSTRACT Background Sexually transmitted diseases (STDs) are epidemic among adolescents. Girls suffer more serious health consequences than boys yet they are often inadequately treated. Many girls with pelvic inflammatory disease (PID) are initially evaluated in Pediatric Emergency Departments. The Centers for Disease Control (CDC) recommend hospital admission for adolescents with PID, a leading cause of infertility, reflecting the need for aggressive management in these patients. This study surveyed physician members of the Section on Pediatric Emergency Medicine of the American Academy of Pediatrics by telephone and mail to determine attitudes and practices related to the management of PID in adolescent girls. Methods Of a total membership of 501, 96 pediatricians were randomly selected and 54 (56%) completed the survey (78% by telephone &amp; 22% by follow up mail questionnaire); most (95%) had teaching responsibilities and were fellowship trained (61%). Geographic distribution included: East 33%;South 24%; Midwest 28%; West 15%. All saw patients up to age 18 years and 31% saw patients to age 21; most (70%) worked in an urban setting and estimated that the large majority of their patients were from poor minority groups. Results 51 (94%) had diagnosed PID within the past 2 years and 37 (69%) diagnosed PID, on average, once a month or more. Nearly two thirds of physicians surveyed indicated that they thought that the care of an adolescent with an STD should be different from that of an adult and that this age group was more prone to medical complications. However, the majority, 28 (52%), did not routinely admit girls with PID. Among those treating on an outpatient basis, just over half arrange follow up within 72 hours of initial treatment as recommended in CDC guidelines for adults, and most do this by providing a phone number. While most emergency physicians routinely suggest condom use (87%) and HN testing (63%) after diagnosing an STD, a minority routinely provide contraceptive counseling (43%) or partner notification (32%). Conclusions The results of this survey suggest that pediatric emergency department physicians frequently diagnose PID in adolescent girls yet many do not follow CDC management guidelines for inpatient admi and provide less than optimal counseling for high risk adolescents. Physician education regarding CDC guidelines and an appreciation of the concerns which lead to their formulation may improve the care of adolescent girls with PID.
American Academy of Pediatrics eBooks, Jul 4, 2005
ABSTRACT Menstrual bleeding that falls outside the range of normal in adolescents is often a caus... more ABSTRACT Menstrual bleeding that falls outside the range of normal in adolescents is often a cause of great concern for both girls and their families. Often, much of this anxiety can be alleviated with proper anticipatory guidance about menarche and early menstrual bleeding patterns. Eliciting a menstrual history from an adolescent girl is challenging, and the use of concrete methods to chart their patterns and flow, such as menstrual calendars and pictorial bleeding assessment calendar (PBAC) tools, may be helpful. The importance of obtaining a confidential history from the adolescent girl cannot be overestimated. A confidential sexual history is essential so that pregnancy and infectious causes of bleeding are addressed. Not all menstrual bleeding in young girls is attributable to immaturity of the HPO axis. Anovulation and DUB from other clinically relevant conditions in adolescent girls must also be considered. Chief among these is PCOS, which should always be ruled out when a girl presents with excessive bleeding associated with clinical signs of hyperandrogenism, obesity, or insulin resistance. Attention must also be paid to signs or a family history of a bleeding disorder, as vWD is commonly associated with excessive uterine bleeding. Importantly, the laboratory testing for both PCOS and vWD is affected by therapies for the excessive bleeding, and it should be performed before hormonal interventions or blood products are administered or during the placebo phase if treatment has begun. Management goals for excessive uterine bleeding include stabilizing the endometrium and stopping further blood loss, as well as preventing future uncontrolled blood loss. Hormonal stabilization of the endometrium is often helpful regardless of the cause of bleeding and especially in those with hormonally mediated anovulation. New antifibrinolytics, such as tranexamic acid, may also be helpful in the emergent setting and in adolescents with bleeding disorders.
Journal of Pediatric and Adolescent Gynecology, Dec 1, 2020
Study ObjectiveWe aimed to describe fertility desires in healthy adolescent females and to explor... more Study ObjectiveWe aimed to describe fertility desires in healthy adolescent females and to explore associations of fertility desire with conditions and therapies potentially compromising fertility.DesignThis was a cross-sectional, anonymous survey.Setting and ParticipantsA total of 323 female adolescents aged 13-19 years were recruited from clinic waiting areas at a children's hospital. We oversampled on days when clinics serving adolescents with potential fertility compromise were scheduled.Main Outcome MeasuresWe measured fertility desire by agreement with the statement “I want to have children someday.” To measure compromised fertility we asked “In the past year, has a doctor, nurse or other medical professional ever talked to you about the possibility that you may have decreased fertility and may not be able to have your own biological child someday?” To measure depression severity, we used a validated scale, the PHQ-9, scores were dichotomized into no/mild and moderate/severe depression.ResultsMean age was 16.06 ± 1.87 years. Of the 323 participants, 57% identified as Hispanic, 24% as Black, 93.5% as cisgender, 6.5% as transgender/gender diverse, 70% as heterosexual, and 30% as sexual minority. A total of 35% had moderate/severe depression, and 12% had compromised fertility. Overall, 89% wanted children. Fewer transgender/gender diverse than cisgender participants wanted children (67% vs 93%, P < .001), as did fewer with moderate/severe versus no/mild depression (83% vs 93%, P < .05), whereas those with compromised fertility versus those without and heterosexual versus sexual minority participants had similar fertility desires. Transgender/gender diverse identity (odds ratio, 0.33; 95% confidence interval, 0.11-0.97; P < .05) and moderate/severe depression (odds ratio, 0.45; 95% confidence interval, 0.22-0.93; P < .05) were independently associated with lower fertility desire.ConclusionsWe found a high overall proportion of female adolescents desiring future children, and only 2 independent predictors of decreased fertility desire, namely, transgender/gender diverse identity and moderate/severe depression.
Journal of Pediatric and Adolescent Gynecology, Dec 1, 2021
OBJECTIVES To compare body mass index (BMI) changes in adolescents using long-acting reversible c... more OBJECTIVES To compare body mass index (BMI) changes in adolescents using long-acting reversible contraceptives (LARCs), etonogestrel subdermal implant (ENG-implant), levonorgestrel intrauterine device (LNG-IUD) and copper IUD (Cu-IUD) by initial BMI category from time of LARC insertion to within 6-18 months after insertion. DESIGN Single-center retrospective cohort study. SETTING & PARTICIPANTS We reviewed electronic health records from our large health system to identify and follow a cohort of 196 adolescents aged 14-19 years with LARCs inserted from 2010 to 2016. We excluded adolescents with conditions or medications affecting weight, including childbirth. MAIN OUTCOME MEASURE BMI change from LARC insertion to first BMI documented after 6-18 months. RESULTS Mean age was 17.2±0.2 years; 59% Hispanic, 29% Black; mean BMI 26.4±7.1 kg/m2; 51% underweight/normal; 24% overweight; 25% obese. Mean time to first BMI documented after LARC insertion was 10.1±3.2 months. Mean BMI change for the total cohort was +0.73±1.8 kg/m2 indicating weight gain. Mean BMI change for ENG-implant + LNG-IUD users (N=127) was larger than for Cu-IUD users (N=69) [+0.92±1.9 kg/m2 vs. +0.37±1.6 kg/m2, respectively, p<.05]. Two-way ANOVA showed both initial BMI category (p=.001) and type of LARC (p=.011) had an independent significant main effect on BMI change. A significant interaction effect (p=.017) showed that obese adolescents had a larger increase in BMI when they were using a progestin-releasing LARC as compared to a Cu-IUD (p<.05). CONCLUSION Adolescents using progestin-releasing LARCs, have a larger increase in BMI within 6-18 months after device insertion than those using Cu-IUDs. The disproportionate increase in BMI with progestin-releasing LARCs is primarily contributed by obese users.
The Early Adolescent Girl: Ages 10-13 The Middle Adolescent Girl: Ages 14 - 17 The Young Adult Wo... more The Early Adolescent Girl: Ages 10-13 The Middle Adolescent Girl: Ages 14 - 17 The Young Adult Women: Ages 18-22 The Female Body Image Physchosexual Development Negotiating Confidentiality The Mother-Daughter-Female Clinician Triad Issues for Male Clinicians Ethical and Legal Issues The Health Maintenance Visit The Preparticipation Sports Physical Reproductive Health for Girls with Chronic Illness Contraceptive Counselling and Prescription Overweight, Underweight and Dieting Depression and Suicide Tobacco, Alcohol and other Drugs Breast Disorders Common Dermatological Problems Abdominal Pain Menstrual Dysfunction Disorders of Vulva, Vagina and Cervix Genital Human Papillomavirus Infection in Adolescents Management of Adolescent Pregnancy Abortion Lesbian Adolescents Sexual Assault, Rape and Sexual Abuse
Journal of Pediatric and Adolescent Gynecology, Aug 1, 1997
To explore the attitudes of inner-city minority female adolescents toward medical and surgical ab... more To explore the attitudes of inner-city minority female adolescents toward medical and surgical abortion to determine if medical abortion methods, which have been shown to be both effective and safe, might have greater appeal than surgical abortion. A cross-sectional, self-administered survey. The waiting room of an inner-city hospital-based adolescent clinic. At total of 157 female adolescents aged 13 to 21 years; Hispanic (56%) and African American (31%). Most (94%) were sexually active, 43% had been pregnant, and 29% had previously had a surgical abortion. An 86-item questionnaire examining attitudes toward medical and surgical abortion safety and impact on future fertility, and pregnancy, abortion, and sexual history. A total of 68% believe that abortion is safe, and 55% believe that having an abortion is better than having an unwanted child. Belief in the safety of abortion was significantly associated with older age and with never having had an abortion. Almost three fourths (72%) believe that having an abortion might impair future fertility either from surgical damage (73%) or &quot;as a punishment for having an abortion&quot; (38%). The majority (72%) believe that &quot;the more abortions you have, the harder it will be to get pregnant in the future.&quot; Regardless of personal abortion experience, 51% believe that a medical abortion would be safer than a surgical abortion. A minority (34%) believe that it would be easier to get pregnant after a medical abortion than after a surgical one. Although most inner-city, minority adolescents believe that abortion is safe, they also believe they risk their future fertility by having an abortion. The availability of medical abortion regimens would greatly influence decisions regarding abortion.
Uploads
Papers by Susan Coupey