Menstrual irregularities are common in puberty and adolescence during the development of ovarian function and until a regular ovulatory cycle. Most irregularities are transient and self-limited but some are severe and prolonged and require exploration and treatment. Some symptoms (particularly oligomenorrhea) may herald an incipient or preexisting endocrinopathy that requires diagnosis and treatment. Abnormalities of the type of bleeding (menorrhagia, metrorrhagia, hypermenorrhea) are treated symptomatically, mainly with hormonal approaches. Of the abnormalities of bleeding rhythm, oligomenorrhea (much more than polymenorrhea) can signify a relevant underlying endocrinopathy.

Adolescents with persisting oligomenorrhea should be evaluated. A basic hormone panel is appropriate. Hypothalamic, pituitary, hyperprolactinemic, hyperandrogenemic and ovarian forms of oligomenorrhea should be distinguished to plan further diagnostic steps and prompt treatment.

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