Adolescent Gynaecology Consultation – the first visit

Adolescents come for a first consultation for very different reasons: severe period pain, irregular cycles, questions about contraception or physical development, suspected PCOS, or simply the need for a trustworthy point of contact. At the practice of Dr. med. Anna M. Wagner at Spalenvorstadt 3 in Basel, every question is welcome – even if it feels embarrassing.

Risk factors

• –Heavy or painful menstruation (dysmenorrhoea)
• –Very heavy or prolonged bleeding (menorrhagia)
• –Absent first period
• –Very irregular cycles
• –Suspected PCOS (irregular cycles, acne, increased body hair)
• –Recurrent infections
• –Questions about HPV vaccination or contraception
• –Uncertainty about physical development

Frequency

Period pain affects up to 90% of adolescents – many mistakenly accept it as inevitable. Severe pain can be caused by a treatable underlying condition that should be identified early.

Typical symptoms

• –Severe menstrual pain that limits daily activities
• –Very heavy or prolonged bleeding
• –Absence of the first period by age 16
• –Very irregular cycles over an extended period
• –Acne, increased body hair, or weight gain suggesting possible PCOS
• –Recurrent lower abdominal infections

Common incidental findings

• –Ovarian cyst as an incidental finding on abdominal ultrasound
• –Uterine malformation as a cause of pain
• –Iron deficiency due to heavy bleeding

When is it detected?

Many symptoms are dismissed as 'normal' and only assessed late. Severe period pain or very heavy bleeding should be medically assessed promptly – effective treatments are available.

Examinations

• –Detailed conversation: cycle, symptoms, questions, history
• –Abdominal ultrasound: assessment of the uterus and ovaries through the abdominal wall
• –Blood test: hormone status, iron levels, thyroid if needed
• –HPV vaccination counselling and administration
• –Contraception counselling: all methods, without pressure
• –Clinical examination: only if necessary and consented to, with a full explanation beforehand

What do the findings mean?

Severe period pain that does not respond to ibuprofen can indicate endometriosis – even in adolescents. Very irregular cycles with acne and increased body hair can indicate PCOS. Both conditions are well treatable if detected early.

Watchful waiting

Mild cycle disorders or occasional pain can initially be observed and treated symptomatically. Follow-up appointment after a few cycles, depending on progress.

Medication

Severe period pain often responds well to ibuprofen or other painkillers. If endometriosis or PCOS is suspected, hormonal therapies or other measures may be helpful – discussed individually, without pressure. The pill is not the only option.

Surgery

Surgical procedures are rarely necessary in adolescents and are only recommended with a clear indication. If endometriosis is suspected, drug treatment is tried first.

• –HPV vaccination: in Switzerland a nonavalent vaccine is used – effective against the most important high-risk HPV types. Optimal before first sexual intercourse, but still worthwhile afterwards. It is recommended and fully covered by the cantonal vaccination programmes up to the 27th birthday – since 2024 as a basic vaccination for all adolescents, including boys.
• –Even vaccinated women should still attend recommended screening exams later on – vaccination does not fully replace the Pap smear.
• –Have severe period pain assessed early – endometriosis often begins in adolescence and often goes unrecognised for years.
• –Check for iron deficiency in cases of heavy bleeding – blood count and ferritin can be easily measured.

• Annual check-up and Pap smear→

  First consultation, HPV vaccination and examination at your own pace – speculum-free if you prefer.

• Period pain→
• Heavy menstrual bleeding→
• PMOS (formerly PCOS)→
• Cycle disorders→
• Gynaecological ultrasound→
• Contraception→

• ↗BAG – HPV-Impfung Schweiz
• ↗SGGG – Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe
• ↗Krebsliga Schweiz – HPV und Gebärmutterhalskrebs
• ↗AGPD – Arbeitsgemeinschaft Pädiatrische Dermatologie / Adoleszenzmedizin