Irregular menses

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Confidential interviewChoose any

HistoryChoose any

Pregnancy riskChoose any

Cycle patternChoose oneFirst line

Signs of excess androgen presentChoose any

Signs of excess androgen absentChoose any

Testosterone resultChoose one

Other featuresChoose any

LabsChoose any

AssessmentChoose one

DiagnosisChoose oneTitle

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PCOS screeningChoose any

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Irregular menses
• Confidential time with the adolescent, with the limits of confidentiality reviewed
• Cycle pattern, acne and hair growth, weight trajectory, and medications reviewed
• No excess hair growth, moderate to severe acne, or signs of virilization
• Irregular cycles most consistent with the normal immaturity of the hormone cycle in the first year after menarche
• Recommended tracking periods with an app or calendar
• Follow up in 3 months

Irregular periods are common in the first year after periods start, while the hormone cycle matures, and they usually become more regular over time. Recommended supportive care with an emphasis on tracking periods, healthy eating, and regular activity. Return precautions given including bleeding that soaks a pad or tampon every hour, dizziness or fainting, no period for 3 months, severe belly pain, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Patient expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Confidential time
Cycle pattern with its time since menarche (first year, over 45, over 35 or fewer than 8 a year, under 21, over 90 days)
Hyperandrogenism present or absent
Free testosterone result
Acanthosis, galactorrhea, thyroid symptoms, restrictive eating
"Targeted laboratory evaluation"
Immature cycles, at risk, PCOS, other cause
"Symptom management discussed"
Depression screen, A1c and lipids, lifestyle

Return precautions in the template

bleeding that soaks a pad or tampon every hourdizziness or faintingno period for 3 monthssevere belly pain

Sources

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (pages reviewed July 22, 2021; no later update notice)
HealthyChildren.org: Penile Adhesions and Skin Bridges
HealthyChildren.org: Varicocele
HealthyChildren.org: Delayed Puberty in Boys
International Evidence-based Guideline for PCOS (2023), adolescent recommendations. Peña AS et al., BMC Medicine 2025;23:151