Irregular Menstrual Bleeding in Adolescence

through the gamut of emotional problems that are created by ignorance or physical embarrassment, or by the girl's special environment. Finally the nurse becomes a court of appeal in questions concerning true anatomical or pathological irregularities. She can, by virtue of her special training, and by her personal example, prove that menstruation is a harmless physiologic function and need seldom be accompanied by psychologic disturbance, physical pain, or incapacity to work. An understanding of the normal menstrual cycle is important as a preface to a consideration of the irregularities which occur when it is beginning. The estrous or ovarian cycle begins with the rupture of a graafian follicle through the covering of the ovary, freeing the ovum, which then enters the Fallopian tube (oviduct) to be met by a sperm from the male and to be fertilized. In the meantime preparations are going on in the ovary and in the uterus for the expected pregnancy. The follicle from which the egg has ruptured now fills in with yellow cells and becomes the corpus luteum, an important organ of internal secretion during the first three months of pregnancy. The walls of the waiting uterus become deep and soft and richly supplied with blood vessels to nourish the awaited inseminated ovum. The fertilized egg itself undergoes certain changes en route through the oviduct which will enable it to attach itself to the walls of the uterus when it arrives. This is the biological cycle that nature has pla n d. However, if, as is most often the case, the ovum is not met by a sperm in the oviduct, these preparations have been made in vain. The follicle heals over, the ovary sets about readying another egg for the next cycle, the unfertilized ovum descends through the uterus and on out, and the uterus, defeated in its purpose, sheds its endometrium and begins to weep its biological tears of blood. But its frustration is not for long. The allseeing pituitary at once begins the preparations for another, and another, ovum until pregnancy can take place and the true biological purpose be fulfilled. This, the tale of a disappointed uterus, is the story which nurses will be called upon time and again to tell. It is, perhaps, the biological frustration underlying the entire phenomenon which lays it open to so many trials and tribulations. Often the sincere telling will be helpful enough to the adolescent, but, unfortunately, all the problems attending menstruation at its onset are not so easy. To give direction to our necessarily brief discussion of these graver issues, we have chosen the following headings: (1) psychic and emotional disturbances, (2) precocious cyclic bleeding, (3) delayed menarche and primary amenorrhea, (4) cryptomenorrhea, (5) oligomenorrhea, (6) menorrhagia, and metrorrhagia, (7) dysmenorrhea, and (8) intermenstrual pains and tenderness.