**9. Explanatory theories**

**6. Ovulatory cycles**

194 Family Planning

ent unknown [9, 35].

**6.2. Treatment**

endometrium.

**8. Dysmenorrhea**

of the genital system [38, 39].

**7. Adolescent functional disorders of uterus**

**6.1. Diagnostic approach**

They are related to disorders or inadequacy of local hemostasis mechanisms and decreased spiral arteriolar density. Endometrial histology varies from productive and secretory to menstrual, and the changes are not different from the corresponding premenstrual women with normal cycles. There is an increased blood flow to the endometrium whereas the levels of circulating ovarian steroids are normal. The endometrial prostaglandin production is increased with a priority to vasodilator PGF2a and angiopathic PGE2 types. Prolonged vasodilation leads to decreased platelet aggregation and increased overexpression of potential parathyroid-related vasodilatory protein. High proteolytic activity of lysosomal enzymes in the endometrium as well as fibrinolysis through increased local secretion of agents with heparin analog activity. The mechanism that triggers all these disorders is pres-

History, gynecological examination, laboratory test such as blood generation, coagulation factors, βhCG, ultrasound through genital organs, parthenoscopy, magnetic resonance, and laparoscopy.

Adolescent medium degree functional disorders of uterus: Hb > 9gr cyclic providing of progesterones, contraceptive pills, and iron preparations. In cases of Hb < 9gr, intravenous hydration, blood transfusion, high dosage of contraceptive pills per os, potential intravenous providing available estrogens continuing usage of contraceptive pills, and iron preparations. Activity of the estrogen-progesterinoides agents in haemostasis led to: increasing of TXA2, platelet agglutination, prothrombin, Factors VIII and X, reduction of fibronolysis, PGI<sup>2</sup>

Metrorrhagia is a symptom, not a specific disease entity. The effectiveness of treatment is based on proper diagnosis. It is very important to establish the stabilization of ovulation

It is a Greek word that has prevailed in the international bibliography as painful menstrual bleeding 2–3 years after menstruation with onset of ovulation. Frequent disturbance of adolescence ED has primary—no organic damage to the pelvis and secondary—painful ER due to pelvic conditions such as endometriosis, pelvic inflammation, and congenital abnormalities

cycles. Therapeutic intervention always takes seriously the young of the age [36, 37].

Theory of Hippocrates: Cervical lumen stenosis and the induced posture of stomach blood are responsible for the occurrence of dysmenorrhea. Myometric factor: increased myometrial activity and increased endometrial pressure. Neuromic factors: changing neuromuscular activity in the uterus after pregnancy may explain the reduction in menstruation pain after childbirth.


Increased levels of PGF2a and PGE2 and increased PGF2a/PGE2 ratio are observed in adolescents with PD. Also increased levels of LTC4, LTD4, and LTE4 angiotensins, stimulation of myometrial contractility, and increase in plasma hormone concentrations in women with dysmenorrhea [38, 39].

#### **9.1. Psychological factors**

Subjectivity and fluctuation of the pain, dysmenorrhoea very often presented in family history.

#### **9.2. Clinical features of dysmenorrhea**

Subabdominal pain, nausea, vomiting, diarrhea, irritability, headache, flatulence payment of forces, depression, and inability to concentrate are clinical features of dysmenorrhea.

#### **9.3. Treatment of dysmenorrhea**

PGs synthetase inhibitors, non-steroidal anti-inflammatory agents act by lowering levels of PGs by reducing levels of PGs, tolfenamic acid, naproxen, and mefenamic acid. The release of PGs into the menstruation blood is maximal in the first 48–72 hours of EGFR. Contraceptive pills reduce the amount of menstruation blood, through the controlled increase of the thickness of endometrial tissue. By inhibiting of ovulation, an endocrine environment with low levels of PGs is maintained.

Other therapeutic proposals are spasmolytics, analgesics, calcium inhibitors, progesterone, magnesium, GnRH analogues, leukotriene antagonists, cervical curettage, acupuncture, electricity stimulation, and psychotherapeutic methods [39, 40].

#### **9.4. Pelvic pain**

in

Primary care of the gynecologist specialized in child and adolescent gynecology is the investigation of women with chronic pelvic pain. The rate of disease varies among teenagers between rarity and 19–47% [41, 42]. Typical forms of chronic pelvic pain are relatively common and non-recognition may underestimate their incidence. Mostly have primary secondary dyspnea and dysmenorrheal. In girls, the gynecological examination is not feasible and the rectal examination provides little information. The ultrasound provides information on a possible chocolate cyst, hematosalpinx, and free fluid in the Douglas space. In non-response to NSAID medication, MRI and laparoscopic approaches are recommended with a detection rate in the specific cases of endometriosis approaching approximately 50%. Endometriosis symptoms in this age group are not specific, not related to adults, but gives continuous pain and a normal menstrual cycle. Atypical forms of endometriosis are more common in teenagers and their non-recognition may underestimate their frequency [43–45].

**3.** Irreversible

• Tubal ligation

• Levonorgestrel

**11. Contraceptive pills**

• Seminal duct ligation **4.** Emergency contraception

• Ulipristal acetate [46–49].

cies and sexual transmitted diseases.

complications are also included.

**11.1. Impact of thrombophilia**

• Total population: 1 per 10,000 woman years per year.

• Contraceptive pills: 4 per 10,000 woman years per year. • Pregnancy: 10–20 per 10,000 woman years per year [56].

It is a complex issue that causes family embarrassment to healthcare professionals in government officials in civil servants and young people themselves. There has been extensive effort to increase the use of contraceptive methods and in particular the condom to avoid pregnan-

Causes of Visiting Teenagers in the Pediatric and Adolescence Examining Room

http://dx.doi.org/10.5772/intechopen.72979

197

Definitely it is necessary to set up Family Planning Centers for Teenagers, which must become a priority for each government. Basic award principle for contraceptive pills, as long as necessary, as little as possible [50]. Contraceptive capacity of contraceptive pills is estimated by the Pearl Index (Pearl Index). All formulations with combined oral hormonal contraception have Pearl index ≤1.25 women (years). There are several differences regarding the hormonal components contained in each formulation which may vary depending on the type, composition, quantity, and number of active tablets. Single-phase formulations contain active tablets with the same constant amount of estrogen and progestogen ratio. In contrast, the above ratio changed in the multiphase pills. Biphasic have two different combinations, the three phase and recently there are also four phases with successive decrease in the estrogen ratio and corresponding increase in the progestogen ratio. Contraceptive pills have not been associated with weight gain and mood changes. It is recommended to take single-phase pills in teenagers for their menstrual bleeding disorders [51–55].

Contraindications of contraceptive pills are BP ≥160/100 mmHg, liver disease, migraines with focal neurological symptoms, diabetes, nephropathy, neuropathy, retinopathy, or angiopathy

History of thromboembolism (particularly with third generation pills with drospirenone), thrombophilia, factor V Leiden mutation, factor II mutation (G20210A allele), antiphospholipid antibodies, protein C deficiency, protein S deficiency, antithrombin III deficiency, undiagnosed vaginal bleeding, and estrogen-dependent breast cancer compromise contraindications for contraceptive pills. Smoking is a relative contraindication for the use. According to FDA (April 2012), revision of contraceptive pills guidelines with drospirenone increases three times the risk of thrombosis compared to other progestogens. Clots are caused by contained estrogen.

Primary care is the detection of adolescents with chronic pelvic pain experienced by endometriosis or other pathology. Irritable bowel syndrome is a common bowel dysfunction without attributing to specific etiology. It is characterized by recurrent chronic abdominal and pelvic pain combined with bowel dysfunction either as diarrhea or constipation. It is found in 50–80% of women with chronic pelvic pain and diagnostic criteria are proposed for diagnosis criteria against Rome ii.

Another cause of pelvic pain is congenital abnormalities of the genital system. Clinical symptoms are amenorrhea, metrorrhagia, dysmenorrhea, endometriosis, repetitive abortions, in cases of pregnancy, abnormal position and presentation of fetus, and premature birth [43–45]. Treatment of abdominal pain is a challenge for the specialized gynecologist especially when an exact diagnosis has not been made. Particularly in these young people, there is a major harmonic relationship between a young doctor and his/her parents in order to find an organic cause of the reported symptomatology or in cases where there is no finding of a treatment analogous to the subjective cause [43, 44].

### **10. Contraceptive methods**

The purpose of contraception is to prevent fertilization of the ovum from the sperm or to prevent implantation of the fertilized egg in the uterus. There are many methods of contraception for everyone to be educated. The ideal method of contraception attaches to the prevention of an unwanted pregnancy but also protects against sexually transmitted diseases. Of approximately, 3 million unwanted pregnancies that occur in the United States, 54% of these do not use contraception.

#### **10.1. Contraceptive methods**

Natural methods: withdrawal method (coitus interruptus) of approximately 57% is used in adolescent women with a failure rate of about 22% and lack of protection against sexually transmitted diseases.

	- Men's condoms
	- Hormonal methods (contraceptive tablets, vaginal ring, transdermal patches)
	- Other methods (contraceptive diaphragm, cervical cap)
	- Intrauterine device
	- Implants

**3.** Irreversible

possible chocolate cyst, hematosalpinx, and free fluid in the Douglas space. In non-response to NSAID medication, MRI and laparoscopic approaches are recommended with a detection rate in the specific cases of endometriosis approaching approximately 50%. Endometriosis symptoms in this age group are not specific, not related to adults, but gives continuous pain and a normal menstrual cycle. Atypical forms of endometriosis are more common in teenag-

Primary care is the detection of adolescents with chronic pelvic pain experienced by endometriosis or other pathology. Irritable bowel syndrome is a common bowel dysfunction without attributing to specific etiology. It is characterized by recurrent chronic abdominal and pelvic pain combined with bowel dysfunction either as diarrhea or constipation. It is found in 50–80% of women with chronic pelvic pain and diagnostic criteria are proposed for diagnosis criteria against Rome ii. Another cause of pelvic pain is congenital abnormalities of the genital system. Clinical symptoms are amenorrhea, metrorrhagia, dysmenorrhea, endometriosis, repetitive abortions, in cases of pregnancy, abnormal position and presentation of fetus, and premature birth [43–45]. Treatment of abdominal pain is a challenge for the specialized gynecologist especially when an exact diagnosis has not been made. Particularly in these young people, there is a major harmonic relationship between a young doctor and his/her parents in order to find an organic cause of the reported symptomatology or in cases where there is no finding of a treatment

The purpose of contraception is to prevent fertilization of the ovum from the sperm or to prevent implantation of the fertilized egg in the uterus. There are many methods of contraception for everyone to be educated. The ideal method of contraception attaches to the prevention of an unwanted pregnancy but also protects against sexually transmitted diseases. Of approximately, 3 million unwanted pregnancies that occur in the United States, 54% of these do not use contraception.

Natural methods: withdrawal method (coitus interruptus) of approximately 57% is used in adolescent women with a failure rate of about 22% and lack of protection against sexually

• Hormonal methods (contraceptive tablets, vaginal ring, transdermal patches)

• Other methods (contraceptive diaphragm, cervical cap)

ers and their non-recognition may underestimate their frequency [43–45].

analogous to the subjective cause [43, 44].

**10. Contraceptive methods**

196 Family Planning

**10.1. Contraceptive methods**

**1.** Reversible (small time action) [46–49].

**2.** Reversible (long time action) [46–49].

transmitted diseases.

• Men's condoms

• Intrauterine device

• Implants

	- Levonorgestrel
	- Ulipristal acetate [46–49].
