This special issue illustrates the wide ranging nature of the field of adolescent reproductive health. It is interesting that the articles accepted relate mostly to developmental abnormalities, reproductive wellbeing and gynaecology, whereas despite its global importance there is only one paper on obstetrical matters. Jones et al., on page 200, report on 500 pregnant adolescents and found that teenagers who were underweight at booking and those that did not grow during pregnancy were more likely to have small-for-gestational-age infants. The socioeconomic implications and problems of adolescent pregnancy are carefully discussed.
Some clinical problems such as menstrual dysfunction are very common in adolescents and although serious pathology is rare, distress levels are often high. At the other end of the spectrum are rare conditions that need specialised expertise. This group includes disorders of sexual development. Gynaecologists dealing with adolescents need to be informed about both the frequently occurring conditions and those that are less common but often more serious. Jane MacDougall and colleagues, from the British Society of Paediatric and Adolescent Gynaecology, on page 131 propose the setting up of networks across the UK for the management of rare and complex conditions to achieve an expert multidisciplinary approach. This proposal is echoed by Melanie Davies on page 134, who argues that young women with Turner syndrome need special care to make a successful transition from paediatric to adult care, and describes the University College London Hospital (UCLH), UK model. The opportunity for preserving the fertility of girls with mosaic Turner syndrome by oocyte cryopreservation is discussed in two case reports, one from the UCLH group on page 234 and the other from Leeds on page 238, in which, for the first time in the literature, normal genetic competence of the oocytes has been demonstrated.
Fertility preservation is also discussed in detail in the comprehensive review by Schmidt et al. on page 163 who outline ways to minimise the effects of cancer treatment on subsequent reproductive function. On occasion, gynaecologists may need to discuss fertility options with a child and their family before, or even many years after, treatment for childhood cancer. Various methods have been used to maximise chances for late fertility in the survivors. The paper by Schmidt et al. provides a clear and useful overview of both historical literature and the current clinical situation.
Melissa Parker and her team report on page 185 menstrual patterns in over 1000 adolescent girls. Menstrual pain was very common (93%) and caused school absence in 26% of the girls studied. Although most were managed by simple treatments, a subgroup did require gynaecological referral. The paper by Margaret Zacharin on page 156 further expands upon the evolving needs of the growing child through puberty and adolescence. Menstrual dysfunction can be very difficult to manage in girls with learning difficulties. Whereas the Mirena Intrauterine System® (levonorgestrel-releasing intrauterine system) has been widely used in adult women, it may be even more beneficial in this vulnerable group of girls, as illustrated by the paper by Mary Pillai and colleagues on page 216.
Ovarian cysts are relatively common and Hernon et al. on page 181 report a series of 115 children undergoing surgery for ovarian cysts in Liverpool between 1991 and 2007. Ninety of these children underwent oophorectomy, many for benign aetiologies. The authors call for greater use of preoperative imaging and assessment and the involvement of gynaecologists together with the paediatric surgeons under whose care these children are often admitted. The need for expert imaging is also highlighted in the series by Michala et al. on page 212 of patients with a presumed diagnosis of an absent uterus which was subsequently found to be incorrect.
Polycystic ovary syndrome (PCOS) is the commonest endocrine problem experienced by women. The scene is usually set in adolescence and it appears that adolescent girls with oligomenorrhoea for more than 2 years after menarche have an extremely high likelihood of having PCOS. In this issue we publish three papers that describe new data on the association between hyperandrogenaemia and disturbed gonadotrophin-releasing hormone pulsatility (Burt Solorzano et al. on page 143), an overview of the clinical manifestations of PCOS and altered reproductive physiology (Shayya and Chang on page 150) and new parameters for defining the metabolic syndrome in young women with PCOS (Dewailly et al. on page 175).
Another hot topic is the recent introduction of vaccination of schoolgirls against human papillomavirus, which is covered in an excellent and comprehensive overview by Crosbie and Brabin on page 137. The choice of vaccine and the why, when and how are discussed together with the challenges. One such challenge is picked up by Forster et al. on page 229, who explored whether parental consent for vaccination was perceived by adolescent girls as ‘parental authorisation for sexual activity’. It was reassuring that about 90% of those questioned did not believe this to be the case and a useful insight is provided into the beliefs of adolescent girls and sexual behaviour.
By the very nature of this special issue we cannot provide a comprehensive overview of all aspects of adolescent reproductive health. We hope, nonetheless, that you will find interest in both the common and not so common issues that are presented and discussed.