ABSTRACT
Polycystic ovary syndrome (PCOS) is frequent during adolescence (prevalence ≈ 6â %), and the prevalence increases in obese or type 1 diabetic (T1D) adolescent girls. During puberty, PCOS diagnosis is difficult because of the overlap with some pubertal physiologic signs. The 2017 international consortium suggests two required diagnostic criteria: persistent menstrual disturbances and hyperandrogenism. PCOS physiopathology is complex, including interactions between genetic, epigenetic factors, primary ovarian abnormalities, neuroendocrine alterations, hormonal and metabolic factors. Insulin seems to have a central place in obese or T1D adolescent girls. The treatment is still debated and should be monitored according to the main symptoms.
Le syndrome des ovaires polykystiques (SOPK) est fréquent à l'adolescence (prévalence ≈ 6â %), et la prévalence augmente en cas d'obésité ou de diabète de type 1 (DT1). À l'adolescence, le diagnostic du SOPK est difficile en raison de signes communs avec la puberté physiologique. Le consortium international de 2017 propose deux critères diagnostiques indispensablesâ : les troubles du cycle menstruel et l'hyperandrogénie. La physiopathologie du SOPK, partiellement élucidée, est complexe, impliquant l'interaction entre des facteurs génétiques et épigénétiques, des anomalies ovariennes, des altérations neuroendocrines, des facteurs hormonaux et métaboliques. L'insuline semble avoir un rôle central chez l'adolescente obèse ou avec DT1. Le traitement fait encore l'objet de discussion et doit être adapté selon les signes prédominants.
Subject(s)
Diabetes Mellitus, Type 1/epidemiology , Pediatric Obesity/epidemiology , Polycystic Ovary Syndrome/epidemiology , Adolescent , Female , Humans , Insulin Resistance , PubertyABSTRACT
The vaginal examination is too often part of the routine in periodic gynecological consultations. However, its performance as a screening examination for gynecological diseases such as cancers and infections is poor when performed in the asymptomatic patient. It is appropriate for cervical cancer screening every 3 years from the age of 21. Moreover, the intrusive nature of the vaginal examination, which is sometimes experienced as traumatic by patients, encourages the targeting of indications for its practice. Fear of this examination may also result in avoidance of care. The gynecological consultation is a privileged setting for screening for sexual risk taking or domestic violence, but also for exploring overall sexual health and promoting women's health.
L'examen vaginal est trop souvent ancré dans la routine des consultations périodiques en gynécologie. Or, sa performance comme examen de dépistage des maladies gynécologiques telles que cancers et infections est mauvaise lorsqu'il est effectué chez la patiente asymptomatique. Il est justifié tous les 3 ans à partir de 21 ans dans le cadre du dépistage du cancer du col utérin. De plus, le caractère intrusif de l'examen vaginal parfois vécu comme traumatisant par les patientes incite à cibler les indications à sa pratique. La crainte de cet examen peut en outre se manifester par un évitement des soins. La consultation gynécologique est un espace privilégié pour dépister des prises de risque sur le plan sexuel ou des violences domestiques, mais aussi pour l'exploration de la santé sexuelle globale et la promotion de la santé des femmes.
Subject(s)
Gynecological Examination , Uterine Cervical Neoplasms/diagnosis , Early Detection of Cancer , Female , Humans , Referral and Consultation , Women's HealthABSTRACT
Pelvic congestion syndrome is an underdiagnosed disease, defined as chronic pelvic pain lasting more than 6 months, associated with pelvic varicose veins in premenopausal women. Diagnose is based on imagery after exclusion of other causes of pelvic pains. Echography is first line diagnostic modality. Conservative treatment is often insufficient and pelvic veins embolization is required to improve symptoms.
Le syndrome de congestion pelvienne est une maladie sous-diagnostiquée, définie par la présence de douleurs pelviennes chroniques depuis plus de 6 mois, associées à des varices pelviennes chez les femmes préménopausées. Le diagnostic est basé sur l'imagerie, après exclusion d'autres causes de douleurs pelviennes, avec l'échographie comme examen de première ligne. Le traitement conservateur est souvent insuffisant et une embolisation des varices pelviennes est le traitement de choix pour améliorer la symptomatologie.
Subject(s)
Embolization, Therapeutic , Pelvic Pain/complications , Pelvic Pain/diagnosis , Varicose Veins/complications , Female , Humans , Pelvic Pain/therapy , Pelvis/diagnostic imaging , Syndrome , Treatment Outcome , Varicose Veins/diagnosis , Varicose Veins/therapyABSTRACT
The female athletic triad refers to the interaction between menstrual function, energy availability and bone density. When an imbalance appears between energy input and output, the global health of the athletic teenager is at risk of somatic and/or psychological complications as defined by the RED-S (Relative Energy Deficiency in Sports). In athletic girls menstrual disorder should be seen as an alert. It may be difficult to distinguish it from menstrual irregularity due to immature hypothalamic-hyphophysic-gonadal axis, which can be physiological at that age. A multidisciplinary approach is needed. The challenge is to find a balance between sport practice and prevention of complications due to lack of estrogens.
La triade de l'athlète féminine implique l'interaction entre la fonction menstruelle, la disponibilité énergétique et la densité minérale osseuse. De plus, lorsqu'un déséquilibre s'installe entre les dépenses et les apports énergétiques, la santé globale de l'adolescente sportive est à risque de complications somatiques et/ou psychologiques comme défini par le RED-S (Relative Energy Deficiency in Sports). Chez l'adolescente sportive, le trouble du cycle a donc fonction de signe d'appel. Il peut être difficile à distinguer des irrégularités de cycle liées à l'immaturité de l'axe hypothalamo-hypophyso-gonadique, physiologiques à cet âge. Une prise en charge multidisciplinaire est indiquée. Son défi consiste à trouver l'équilibre entre la pratique sportive et la prévention des complications à long terme dues à la carence Åstrogénique.
Subject(s)
Amenorrhea , Female Athlete Triad Syndrome , Sports , Adolescent , Bone Density , Energy Intake , Energy Metabolism , Female , HumansABSTRACT
BACKGROUND: Securing the adherence over time to contraception by adolescent girls is a challenge. Until now little was known about this topic in Switzerland. The aim of our study was to determine contraceptive continuation rates among adolescents in this country and assess possible predictive factors for discontinuation. METHODS: A prospective observational cohort study of 12- to 19-year-old girls starting contraception was performed. Patients were interviewed again after 1 year by phone, email or postal mail. RESULTS: A total of 204 patients were included, of whom 85.8% chose a combined oestrogen-progestogen pill. The answer rate 1 year later was 71%. Among these, continuation of the initially prescribed contraceptive method was observed in 73.1%. Factors statistically affecting the continuation rate were the initial contraceptive method, the place of residence and sexual activity after 1 year. Classification of contraceptive methods in decreasing order of continuation rate was the following: long acting reversible contraception (LARC) methods, oestrogen-progestogen pills, injections, progestogen pills, patches and rings. Major reasons reported for stopping the prescribed contraceptive method were ending sexual relations (54.3%), developing side effects (34.3%) or changing to another contraceptive method (22.9%). Neither age, nationality, smoking, occupation, nor the legal representative's knowledge of the contraception influenced adherence. CONCLUSION: Contraceptive continuation rate was high among the adolescent population studied. The only predictive factor of discontinuation was the contraceptive method. Our study also reveals that respecting teenagers' confidentiality is essential as it does not negatively impact the continuation rate. The significant impact of the type of contraception on continuation rates stresses the importance of individualised counselling.
