Evidence-Based Clinical Practice
The establishment of a regular menstrual cycle is an important process for an adolescent girl. Psychologically it is a sign of becoming an adult and a factor for female identity. Physiologically it means normal function of the hypothalamic- pituitary-ovarian axis and the system of sexual hormones as the basis for future fertility and reproduction. Disturbances of this regulatory system during its development cause dysfunctional uterine bleeding and are a frequent gynecological problem. Adolescent medicine and gynecology focus on recognizing and influencing abnormalities early to prevent clinical consequences.

The challenge is to distinguish normal individual variation from real endocrine or organic problems. Avoiding too early and unnecessary interventions without missing relevant abnormalities requires a firm grasp of the process of physiological sexual development with the induction of a regular menstrual cycle as well as of the symptoms and etiology of relevant abnormalities. This permits planning of efficient diagnostic testing and appropriate treatment regimes in the sense of evidence-based clinical practice.