Adolescent Gynaecology

The gynaecological issues that present differently in adolescents, and the consent/ confidentiality framework that governs them. Individual conditions are covered in depth on their own pages — this page is the adolescent-specific overlay.

Consent, confidentiality & safeguarding

• Mature-minor (Gillick) competence: an adolescent who fully understands the nature, purpose and implications of a treatment can consent to it themselves, without parental involvement — assess and document competence for contraception, cervical screening (rarely indicated <25), STI care and abortion.
• Offer confidentiality, and explain its limits.
• Actively consider safeguarding: ask about the age of partners and consent; sexual activity in a young adolescent, or a large age gap, raises child-protection concerns with mandatory-reporting obligations that vary by state.

Menstrual problems

• Heavy menstrual bleeding at/soon after menarche: cycles are often anovulatory in the first ~2 years (immature HPO axis). Pelvic ultrasound is usually NOT needed first-line — it rarely changes management. But consider a bleeding disorder — up to ~20% of adolescents with significant HMB have one (von Willebrand disease most commonly) — so take a bleeding history and check FBC/ferritin and coagulation/vWD studies where the bleeding is heavy from the start. Manage as per Heavy menstrual bleeding & AUB (tranexamic acid, combined hormonal contraception, or the LNG-IUD, which is safe in adolescents).
• Dysmenorrhoea is common — NSAIDs and hormonal options first-line; onset well after menarche, or poor response, should prompt thought about endometriosis (refer under-17s to a paediatric/ adolescent gynaecologist).
• PCOS/PMOS — diagnose cautiously. A polycystic ovarian appearance on ultrasound is a normal finding for up to ~8 years post-menarche, and irregular cycles are common early — avoid over-labelling; require both persistent oligo/amenorrhoea and clinical/ biochemical hyperandrogenism (see PCOS (now PMOS)).
• Primary amenorrhoea — investigate/refer per Amenorrhoea.

Contraception in adolescents

• LARC (implant and IUDs) are first-line and safe at this age, including in nulliparous adolescents — the etonogestrel implant has no adverse effect on peak bone mass. Use DMPA with more caution under 18 (reversible BMD effect).
• Balance non-contraceptive benefits (acne, HMB, dysmenorrhoea) when choosing a method. See Contraception: choice & overview and Progestogen-only & LARC.
• Always pair with STI prevention counselling and offer testing; provide emergency contraception access information.

Teenage pregnancy

Higher obstetric and psychosocial risk. Provide non-judgemental options counselling (continuing/parenting, adoption, abortion), confidentiality, antenatal engagement if continuing, mental-health and social support, and safeguarding assessment. Preconception folate/iodine and immunisation review apply as for any pregnancy.

Health maintenance

• HPV vaccination (single-dose Gardasil 9 on the school program; catch-up available).
• Cervical screening is not indicated until 25 regardless of sexual-activity start.
• Mental health, body image and eating-disorder screening as part of adolescent care.