TABLE 3

Menstrual Conditions That May Require Evaluation

Menstrual periods that:
  • Have not started within 3 years of thelarche

  • Have not started by 13 years of age with no signs of pubertal development

  • Have not started by 14 years of age with signs of hirsutism

  • Have not started by 14 years of age with a history or examination suggestive of excessive exercise or eating disorder

  • Have not started by 14 years of age with concerns about genital outflow tract obstruction or anomaly

  • Have not started by 15 years of age

  • Are regular, occurring monthly, and then become markedly irregular

  • Occur more frequently than every 21 days or less frequently than every 45 days

  • Occur 90 days apart even for one cycle

  • Last >7 days

  • Require frequent pad/tampon changes (soaking more than 1 every 1–2 hours)