© 2016, Springer-Verlag Berlin Heidelberg. Purpose: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective method of contraception, while also providing various non-contraceptive benefits. Although targeted primarily to adults, there is increasing experience in its use in adolescence. The aim of this review is to assess the available information on LNG-IUS usage in adolescence. Methods: We conducted an online search on MEDLINE and SCOPUS from inception to May 24, 2015. All studies that examined LNG-IUS use in teen populations were eligible for inclusion. Primary outcome measures included description of indications for LNG-IUS usage and relevant efficacy. Secondary outcomes included complications, such as device-related problems (perforation and expulsion) and other adverse events (pelvic inflammatory disease, PID). Acceptability of the LNG-IUS was also estimated through evaluation of continuation rate and reasons for removal were assessed. Results: Twenty-one studies met our inclusion criteria. We identified only one randomized controlled trial (RCT). All other twenty studies were observational. Pregnancy rates ranged from 0 to 2.7{%}. Management of heavy or/and painful periods was successful in 92–100{%}. Menstrual manipulation in patients with developmental delay was achieved in over 93{%} of cases. Expulsion rates ranged from 0 to 13{%} and pelvic infection/cervicitis between 0 and 2.7{%}. There were no reported uterine perforations. Conclusion: Usage of the LNG-IUS in teen populations appears to be safe and efficacious both in terms of contraception and menstrual management. However, more robust evidence is needed so as to provide firm confirmation on benefits and potential side effects.

© Springer-Verlag GmbH Germany 2017. Lichen sclerosus is a chronic skin disease, mainly localised at the introitus and perineum. When the condition remains untreated, gradual atrophy of skin structures leads to permanent scarring, making early diagnosis and treatment crucial. We reviewed all patients diagnosed with lichen sclerosus presenting to a tertiary referral centre for paediatric and adolescent gynaecology between January 2011 and December 2015 to assess disease presentation and response to treatment. We identified 15 cases, with a mean age at diagnosis of 8.8 years. Their main presenting symptoms were vulvar pruritus and vulvar soreness. Seven girls had already atrophic changes, and in four girls, this amounted to clitoral phimosis, labial resorption or labial adhesion formation. The median delay in diagnosis was 7 months. Thirteen patients received local treatment with potent corticosteroids, responding well to treatment. However, 4 girls relapsed within 2 to 36 months. Two adolescents required surgical treatment, one because of urinary retention and the second because of dyspareunia caused by clitoral entrapment. Conclusions: There was a delay in diagnosis in most patients and this resulted in irreversible genital skin changes, which would have been preventable, had treatment been instituted promptly. The response to treatment with local corticosteroids was usually effective, leading to both symptom alleviation and prevention of disease progression. Atrophic changes and skin complications however were not reversed.

© Journal of Reproductive Medicine®, Inc. BACKGROUND: Menstrual disorders are common in adolescence and are usually caused by an immature hypothalamic-pituitary-ovarian axis. Occasionally, suppressed gonadotropins or a raised prolactin may raise suspicion for a central organic cause of amenorrhea. CASE: We present the cases of 3 adolescents with menstrual irregularities or amenorrhea who were found to have hypothalamic gliomas (2 cases) and a craniopharyngioma (1 case). An MRI of the brain revealed the diagnosis in all 3 cases. CONCLUSION: Although rare, brain disease should be included in the differential diagnosis of menstrual irregularities, particularly in cases of central delayed puberty, moderately raised prolactin, and hypothalamic amenorrhea with no clear functional cause, such as disturbed dietary habits, excessive exercise, or stress.

© 2017 North American Society for Pediatric and Adolescent Gynecology Study Objective To study the presentation and causes of premature ovarian insufficiency (POI) in adolescents. Design Retrospective notes review. Setting Tertiary referral outpatient clinic for pediatric and adolescent gynecology. Participants Adolescents with POI. Interventions Standard POI evaluation. Main Outcome Measures Age and clinical symptoms at presentation, causative factors for POI, if identified. Results We identified 22 girls with POI, with a mean age of 15.6 years. Eight of them presented with delayed puberty, 3 with primary amenorrhea, and the remainder presented with either irregular bleeding (n = 9) or secondary amenorrhea (n = 2). For those who presented with delayed puberty, only 3 were found to have a sex chromosome abnormality. A clear cause for the POI was identified in 3 further cases. Conclusion Although POI in adolescents traditionally is associated with primary amenorrhea and delayed puberty, a proportion of girls will present with irregular bleeding that might be mistaken for expected menstrual disturbances of puberty, thus delaying the diagnosis. We identified a clear cause for POI in 6 cases. Although there were no familial cases of POI, it remains a possibility that genetic reasons might be involved in the pathogenesis.