Abnormal uterine bleeding (AUB) is one of the most common patient concerns in the adolescent population. AUB is defined by menstrual bleeding that occurs outside of the normal range and can include irregular bleeding patterns; prolonged or short bleeding episodes; and heavy or light bleeding. In order to determine abnormal bleeding amounts and/or patterns, it is important to understand the normal parameters for a menstrual cycle in this age group. Nurses and healthcare providers must collect as much information as possible about the menstrual bleeding to help determine the appropriate plan of care.

Ovarian cysts are often evaluated according to the patient's age. In the antenatal period, placental hormones and fetal hormones may stimulate the ovary. Ovarian cysts are not common in the prepubertal female because of low gonadotropin and sex hormone levels. Some functional cysts will activate hormones and result in a prepubertal child presenting with vaginal bleeding or premature breast development. Nonfunctional ovarian cysts also occur in children and may not resolve without intervention. Functional cysts in the pubertal females are often a result of anovulation, with persistence of the remaining follicle and persistence of the corpus luteum.

Combined oral contraceptives contain two hormones, estrogen and progestin. The combined options come in the form of a pill, vaginal ring, or transdermal skin patch. These options are approximately 91% effective as contraception with typical use. The combined hormonal effects prevent pregnancy by inhibiting ovulation, thickening cervical mucus, and thinning the endometrial lining. The progestin-only birth control pills, sometimes known as the “mini-pill”, contain only one progestin hormone called norethindrone. Birth control pills can be initiated at any time when pregnancy can reasonably be excluded.

The etonogestrel implant is a single-rod progestin-only contraceptive method. The implant is a small 4 cm × 2 mm semi-rigid plastic rod containing 68 mg of the progestin etonogestrel and is radiopaque. The hormone is slowly released over 3 years but recent studies suggest the implant can be used up to 5 years. Fewer than one in 100 women become pregnant while using the implant. The contraceptive implant is a highly effective, reversible long-term option for patients in need of contraception. Patients will likely experience menstrual irregularities while having the implant, so effective counseling is important prior to insertion is important.

The etonogestrel implant is a single-rod progestin-only contraceptive method. The implant is a small 4 cm × 2 mm semi-rigid plastic rod containing 68 mg of the progestin etonogestrel and is radiopaque. The hormone is slowly released over 3 years but recent studies suggest the implant can be used up to 5 years. Fewer than one in 100 women become pregnant while using the implant. The contraceptive implant is a highly effective, reversible long-term option for patients in need of contraception. Patients will likely experience menstrual irregularities while having the implant, so effective counseling is important prior to insertion is important.

Patients often seek advice from a gynecology office after a positive at-home pregnancy test. Pregnancy can be diagnosed by both urine and serum testing. A random urine sample can be taken at any time of the day and most standard home pregnancy kits are usually positive within 7 days after the last missed period. The most sensitive home pregnancy tests can detect pregnancy as early as the first day of a missed period. When a patient reports a positive pregnancy test, the nurse should first assess the patient's safety, as some teens may be fearful to notify their partner and/or family members.

Vaginal discharge is characterized by fluid that comes out of the vagina. Normal vaginal discharge is due to endocervical secretions, vaginal flora, and epithelial cells sloughing. Many females will develop a vaginal infection during their lifetime. These symptoms can include vaginal discharge associated with change in color or volume, itching, odor, discomfort, burning, spotting, dysuria, and spotting. Vaginal complaints are a common concern for many patients. Reviewing normal symptoms versus signs of infections is important. Most vaginal complaints need to be addressed during a clinic visit, but the nurse can assist patients in recommended comfort and hygiene measures while awaiting a visit appointment.

Vulvitis is an itching, burning, redness, or rash on the external genitalia. Vaginitis is the irritation of the vagina, and symptoms can include discharge and/or bleeding. When vaginitis and vulvitis occur together, it is called vulvovaginitis. Vulvovaginitis accounts for about 62% of pediatric gynecological problems in primary care. The pediatric population is at higher risk for vulvovaginitis for a variety of reasons, including lack of vaginal estrogen, the smaller size of the labia minor and majora, an alkaline pH of the vagina, poor perineal hygiene, and the proximity of the urethra and anus to the vagina. Treatment for vulvovaginitis depends on the underlying cause.

Depot medroxyprogesterone acetate (DMPA) is an injectable, progestin-only contraceptive that provides effective, reversible contraception. It comes in two doses (DMPA, 150 mg intramuscularly or 104 mg subcutaneously). The only difference between these two formulations is the route of administration. It is highly effective, with only six out of 100 women becoming pregnant in the first year of use with typical use. It is given every 11 to 13 weeks but can be given up to 15 weeks between injections. The return to fertility after discontinuing DMPA may be delayed. In some patients, it may take up to 18 months to return to ovulatory cycles.

The vaginal ring is a rubber-free, silicone birth control that is colorless and nonbiodegradable. It will not dissolve in the body. This ring is easy to insert and is placed anywhere in the vagina that feels comfortable. It was Food and Drug Administration (FDA) approved in 2001. The advantages of the ring include the avoidance of gastrointestinal metabolism, no daily dosing, and a rapid return to ovulation after discontinuation. The ring releases two hormones: 120 mcg of the progestin etonogestrel and 15 mcg of ethinyl estradiol per day. The hormones are slowly and constantly released into the vagina, preventing ovulation.

Pelvic pain constitutes nearly 3% to 5% of all primary care visits. Pelvic pain can be acute or chronic. It is important to separate these issues to help determine the necessary treatment and the urgency of treatment. Chronic pelvic pain (CPP) is defined as pelvic pain occurring for least 6 months. All children and adolescents are susceptible to pelvic pain. CPP often requires a multi-disciplinary approach due to the vast amount of different etiologies. The role of the triage nurse is to help manage the patient's symptoms and answer questions they may have regarding treatment plans.