You asked a PAG – Here’s the Answer!

  • May 5, 2020
  • Paediatric/Adolescent Gynaecology

You asked, we answered! In this article, we’ve collected a few of the questions you sent in about puberty, periods, and gynaecological health in adolescents.

Dr Brooke O’Brien is our specialist Paediatric and Adolescent Gynaecologist. She’s taken some time to answer your questions, and you can see the responses below. Keep reading to find out about more about everything PAG!

Disclaimer: we’ve edited the questions below for clarity and anonymity, and any names have been changed. For more information on a condition or to book an appointment with any of our gynaecologists, please contact us directly.


Emma asks…

My daughter has severe body acne – is that normal?

Dr Brooke Answers…

Many adolescents suffer from mild acne from time to time. However, severe acne or acne that covers extensive areas of the body can signify an underlying medical condition, especially if the sufferer also has other hormonal symptoms (such as irregular periods).

In particular, higher levels of testosterone or insulin (often seen in women with polycystic ovarian syndrome or other endocrine disorders), can cause body acne. If your daughter is suffering from acne that doesn’t respond to the usual treatment methods, it’s important she gets assessed by someone with experience in the area.

In regards to polycystic ovarian syndrome – the usual criteria for diagnosis can only be applied to adult women, and a diagnosis in an adolescent should involve an adolescent gynaecologist.

Acne in adolescents is important to treat properly and adequately – especially as adults, we often underestimate the impact it can have on a teenager’s physical and mental health. Left untreated, acne can cause scars and lifelong physical and psychological damage.

Whilst oral antibiotics (or even stronger oral medications) are very commonly prescribed for acne, most forms can be treated by gentler topical retinoids (prescribed by your doctor) or by addressing the underlying medical condition that’s causing it. Since taking prolonged courses of antibiotics can impact a person’s gut microbiota and overall health, it’s often better to treat acne through another method if possible. If you are concerned that your daughter has acne – particularly if she also has irregular periods, increased hair growth, difficulty with weight control, or if there’s a strong family history of diabetes or polycystic ovarian syndrome – she may benefit from seeing an adolescent gynaecologist.

Charlotte asks…

For the past 2 years, my daughter has had heavy periods – regulated now by an oral contraceptive, but still heavy. She is iron deficient but her haemoglobin levels are ok. We’ve tried several other medications to try halter the bleeding, she’s also gained 15 kg being on the pill.

Dr Brooke says…

The majority of young women will have irregular periods for the first few years after they start – this is because most adolescents don’t ovulate regularly. The chemical signals from their brains are immature and irregulated, which makes ovarian function uncoordinated. This can result in frequent, irregular, or often very heavy bleeding.

The oral contraceptive pill (OCP) is designed for adult women, and to be used for contraceptive purposes. It prevents pregnancy because it includes a synthetic progesterone, which reduces chemical signals from the brain that drive ovulation. In summary, the OCP prevents pregnancy by inhibiting ovulation.

Since the most common reason for abnormal periods in young women is because they’re not ovulating regularly, the OCP often isn’t the best way to control abnormal periods in adolescents.

Many doctors will increase the OCP dose to see if it better controls periods, but this often causes side effects such as nausea, headaches, depression, and weight gain in adolescents. More seriously, it can place them at a higher risk of migraines, blood clots in their legs or lungs, or even strokes.

Addressing the iron deficiency is also very important, since teenagers tend to be very symptomatic of it. It can cause fatigue, difficultly concentrating, trouble attending school and sporting activities, and a flat mood.

In short, the oral contraceptive pill may not be the best management option for your daughter. There are many other options available, and I highly recommend asking your doctor for a referral to a gynaecologist who specialises in adolescent health – some medications affect adolescents and adults in different ways, and consulting someone with experience in this area can make a world of difference.

I wrote an article for QML Magazine earlier this year abut managing heavy bleeding and iron deficiency in young women – you can click here to read it.

Amelia asks…

How will I know when my daughter is going to start her period?

Dr Brooke answers…

All children and adolescents develop at different rates. Most women in Australia get their first one at around age 11 or 12, although some get it is sooner or later.

Usually, the first signs of puberty are breast budding or fine pubic hair – on average, most girls get their first period around 18 months after this starts. As this development continues, adolescents often start to go through a rapid increase in height. This is often accompanied by a huge increase in appetite, as many parents will be aware! These are all signs you can look for to know if your daughter might start having periods soon.

It’s important to prepare your daughter for her first period – teach her about puberty and the developmental changes she can expect; the importance of a healthy diet and regular exercise; and how to use pads, tampons, and practice good period hygiene. This goes a long way in normalising the process and preparing her for coming physical changes.

If you’re worried that your daughter isn’t showing any signs of puberty, it’s best to seek medical advice. If she isn’t showing any signs of breast development by age 13-14 or periods don’t start within two years of breast development. There are a few medical conditions which can cause these delays, and your daughter may benefit from being assessed for them by someone who specialises in adolescent gynaecology.

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