Menstruation: The Next Vital Sign

Roberta Heale Associate Editor, EBN @robertaheale @EBNursingBMJ

In a presentation at the 40th National Association of Pediatric NPs in New Orleans in early March 2019, Joan Mezera and Meara Henley put forward some important ideas about necessary changes in the way health care providers view and assess menstruation in teenage and adolescent female patients.  They proposed that we need to move past only assessing for pregnancy and contraception toward an understanding that issues with menstruation are symptoms of a whole host of conditions.

Amenorrhea can be, of course, a sign of pregnancy. However, other forms of amenorrhea include primary amenorrhea, when menstruation doesn’t begin, or secondary amenorrhea, when menses becomes irregular, scant or stops altogether.  These can be a result of an ovulation abnormality, birth defect, anatomical abnormality, eating disorder, obesity, excessive or strenuous exercise or thyroid disorder.

Dysmenorrhea is severe and frequent menstrual cramps and pain associated with menstruation. There are, again, primary and secondary causes that may include such things as chemical imbalance in the body, endometriosis, pelvic inflammatory disease, uterine fibroids, abnormal pregnancy, infection, tumors, or polyps in the pelvic cavity.  Women and girls are at an increased risk of dysmenorrhea if they are smokers, consume excessive alcohol during their period, are overweight or started menstruating before the age of 11. In addition to cramping and pain, women may also experience nausea, vomiting, diarrhea, fatigue, weakness, fainting and headaches.

A final common menstrual condition is dysfunctional uterine bleeding (DUB).  There are several variations of this including menorrhagia, which is heavy and prolonged menstrual bleeding, polymenorrhea, too frequent menstruation, oligomenorrhea, infrequent or light menstrual cycles and metorrhagia, irregular non-menstrual bleeding that occurs between periods. There are a great number of possible causes of DUB ranging from hormonal imbalance, infection, side effect of some birth control devices and more.

The menstrual cycle holds many clues into the health of a teenage girl and young woman and a full assessment should not be overlooked.  Mezera and Henley indicated that they complete a urine pregnancy test on all the young women they care for, whether or not they have indicated that they are sexually active.  Along with this, they conduct a thorough evaluation of the history and nature of the client’s menstruation. In addition, they evaluate changes in mood, vision, or weight.  They also explore the client’s exercise patterns; presence of galactorrhea; headaches; sleep concerns; sexual activity; unwanted hair growth; and vaginal discharge.  If they are concerned about eating patterns, they may request a 24-hour diet recall.

Nurses are often an important link for adolescent female clients in accessing health care.  Providing access to health care for sexual health and contraception advice is not enough. We need to move beyond the basics and include a comprehensive menstrual health history and related assessment with every young woman we encounter.


Coppock, K. (March 9, 2019). Menstruation: A Vital Tool for Assessing Health in Females. Contemporary Clinic which references the following:

Mezera J, Henley M. Managing “Monthlies”: What the NP needs to know about menstrual management. Session presented at: 40th National Association of Pediatric Nurse Practitioners national conference; March 7, 2019; New Orleans, LA. Accessed March 7, 2019.

Summa Health (2019). Women’s Health OB-GYN, Menstrual Disorders.



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