Adolescence is a critical transitional phase marked by profound physiological, psychological, and social changes. It is during this period that girls experience the onset of menstruation and are increasingly vulnerable to a spectrum of gynaecological issues—ranging from functional menstrual disturbances to infections and hormonal disorders. Recent literature emphasizes that adolescent gynaecologic morbidity often goes underreported or inadequately managed, particularly in developing regions where health-seeking behaviour remains influenced by sociocultural taboos and limited healthcare accessibility [1].

A study by Kalyankar et al. found that nearly 60% of adolescent girls presenting to outpatient clinics reported menstrual complaints, underscoring the prominence of dysmenorrhea, oligomenorrhea, and menorrhagia in this age group [1]. The growing burden of such conditions necessitates a shift from episodic care to comprehensive adolescent-friendly services. The establishment of dedicated adolescent clinics has been advocated as a public health priority, given the increasing awareness and willingness among teenagers to seek professional help for reproductive issues [2].

Gynaecologic infections, including vulvovaginitis and cervicitis, also constitute a significant portion of adolescent morbidity, especially in sexually active or poor-hygiene environments. Singh et al. documented that reproductive tract infections in adolescents were frequently missed at the primary care level due to nonspecific presentation and lack of specialized evaluation protocols [3]. This underscores the need for symptom-driven screening and targeted clinical assessments in outpatient gynaecology.

Moreover, clinical patterns observed in tertiary care centres reflect a changing epidemiological landscape of adolescent health. A recent observational study from a North Indian centre found that menstrual irregularities accounted for over 70% of gynaecologic OPD visits among girls aged 10–19 years [4]. Thaker et al. highlighted similar findings in their review of over 1,000 adolescent patients, emphasizing that menstrual problems are frequently accompanied by abdominal pain, hormonal acne, and signs suggestive of polycystic ovarian syndrome (PCOS) [5].

Adding to this, Agarwal et al. reported a notable increase in the diagnosis of PCOS among adolescents over the past five years, suggesting early metabolic and endocrine disruption that could have long-term reproductive consequences if left unmanaged [6]. These findings collectively support the pressing need to evaluate, document, and address adolescent gynaecologic health in a structured, evidence-informed manner.

The present study was undertaken with the aim of prospectively evaluating the clinical profile, diagnostic trends, and management strategies among adolescent girls attending a gynaecology outpatient clinic in a tertiary care hospital. It intends to provide data that can contribute to the evolving discourse on adolescent reproductive health and guide improvements in early diagnosis and intervention strategies.

This prospective observational study was conducted over a period of six months at the Government General Hospital, Siddipet. The study population comprised 100 adolescent girls aged between 10 and 19 years who presented to the outpatient gynaecology clinic during the study period.

Participants were evaluated through detailed history-taking and clinical examination. Data collection included variables such as age, age at menarche, presenting complaints, physical and gynecological findings, provisional and confirmed diagnoses, investigations performed, and referrals made to other specialties.

The collected data were compiled and analyzed using descriptive statistics to summarize clinical profiles. Inferential statistical analysis, specifically the chi-square test, was employed to determine associations between age groups and selected clinical parameters. A p-value of less than 0.05 was considered statistically significant for all tests performed.

Age Distribution of Adolescent Gynaecologic Presentations

Among the 100 adolescent girls presenting with gynaecologic concerns, the largest proportion (39%) fell within the 13–15-year age group, representing the early to mid-adolescent phase. This was followed by 29% in the 10–12-year group and 32% in the older 16–19-year category. This distribution suggests a consistent flow of gynaecological consultations across adolescence, with a notable concentration in the mid-adolescent years when pubertal milestones and menstrual irregularities become more clinically relevant. The relatively high presentation rate in the youngest bracket also reflects early onset of menarche-related symptoms and the growing awareness or concern among caregivers.

Age at Menarche Analysis
Table 2 illustrates that 35% of adolescents experienced menarche by age 11, 38% between ages 12–13, and 27% at age 14 or later. A one-way ANOVA demonstrated a statistically significant difference in mean age across these menarche groups (F = 6.80, p = 0.0017), indicating that younger adolescents were significantly more likely to report early menarche. This may reflect a combination of genetic, nutritional, and environmental factors influencing pubertal timing.

Table 1. Age Distribution of Participants

Table 2. Age at Menarche Distribution

Presenting Complaints among Adolescent Gynecological Patients

Among the 100 adolescent patients evaluated, the most common presenting complaint was menstrual irregularities, reported by 35% of the cohort. Abdominal pain (28%) and dysmenorrhea (22%) were also frequently encountered. Other complaints included leukorrhea (8%), PCOS-related symptoms (5.6%), and fewer cases of mass per abdomen, itching, hirsutism, acne, urinary symptoms, and miscellaneous issues. When stratified by age groups (10–12, 13–15, and 16–19 years), no statistically significant differences were observed in the distribution of complaints. A chi-square test of independence revealed χ² = 0.339, df = 8, and p = 0.999, indicating that the pattern of complaints remained broadly similar across adolescent subgroups.

This consistency suggests that menstrual and pelvic complaints from the dominant gynaecological issues in adolescence, regardless of age bracket, reinforcing the need for early reproductive health screening protocols that are uniformly applicable across adolescence.

Table 3. Presenting Complaints among Adolescent Gynaecologic Patients

Note: No statistically significant difference in the distribution of presenting complaints across age groups (χ² = 0.339, df = 8, p = 0.999).

Menstrual Irregularities among Adolescent Presentations

Among the adolescents presenting with gynecological issues, menstrual irregularities formed a significant subgroup. Dysmenorrhea was the most frequently reported condition, affecting 15% of the total cohort. Oligomenorrhea and menorrhagia were also common, reported in 10% and 9% of the participants respectively. Less frequently encountered disorders included primary and secondary amenorrhea, reported in 7% and 6% of adolescents. Rare presentations such as metrorrhagia and polymenorrhea were observed in 3% and 5% respectively. These findings underscore the need for structured evaluation of menstrual health in adolescent girls to detect and address underlying endocrinological or gynecologic causes early.

Clinical Diagnosis Distribution

Among the 100 adolescent patients evaluated, menstrual disorders accounted for the majority of clinical presentations. Dysmenorrhea was the most common diagnosis, seen in 32% of the cases, followed by oligomenorrhea (21%) and menorrhagia (16%). Polycystic ovarian syndrome (PCOS) was diagnosed in 12% of the cohort, reflecting the growing prevalence of hormonal disorders in this age group. A smaller proportion presented with infections (10%), predominantly vulvovaginitis. Primary amenorrhea and adnexal masses were infrequent, each accounting for less than 5% of cases. Notably, 2% of adolescents presented with pregnancy-related issues, underscoring the need for sexual and reproductive health education at this developmental stage.

A chi-square goodness-of-fit test was applied to evaluate whether the distribution of clinical diagnoses differed significantly from a uniform distribution across categories. The result was statistically significant (χ² = 59.52, p < 0.001), indicating that certain diagnoses, particularly dysmenorrhea (32%), oligomenorrhea (21%), and menorrhagia (16%), were disproportionately more frequent compared to others such as pregnancy-related issues (2%) or adnexal masses (3%).

Table 4. Distribution of Clinical Diagnoses among Adolescent Gynaecology Patients

Gynecological Examination Findings in Adolescent Girls

Pelvic and per-abdominal examination findings provided further insight into the underlying causes of gynecological presentations among adolescents. The most commonly noted abnormality on abdominal examination was lower abdominal tenderness, often reported in cases of dysmenorrhea or pelvic inflammatory disease. Per-speculum examination was performed selectively in older adolescents and revealed vaginal discharge and cervicitis in a subset of sexually active participants. Per-vaginal examination was rarely conducted and limited to those requiring further evaluation for suspected pelvic pathology. The findings underscore the need for age-appropriate, symptom-driven clinical assessment protocols in adolescent gynecologic care.

Table5: Distribution of Clinical Examination Findings

Investigations and Referrals among Adolescent Gynaecology Patients

Diagnostic evaluations and specialist referrals were pursued based on clinical findings and presenting complaints. Pelvic ultrasound emerged as the most frequently utilized investigation (45%), underscoring its central role in evaluating structural abnormalities and menstrual irregularities. Hormonal panels (22%) and complete blood counts (18%) were also commonly ordered, particularly in cases of suspected endocrine dysfunction or anaemia. Thyroid profiles were checked in 12% of cases. A subset of patients was referred to endocrinologists (8%) or surgeons (4%) for conditions beyond routine gynaecological scope. Notably, 30% of adolescents did not require any investigations, highlighting the sufficiency of clinical diagnosis in selected cases.

To assess the distribution pattern statistically, a chi-square goodness-of-fit test was performed on the frequencies of investigation and referral categories. The results indicated a significant deviation from uniform distribution (χ² = 60.27, p < 0.001), confirming that certain diagnostic modalities—particularly ultrasound—were disproportionately preferred based on clinical relevance.

Table 6. Investigations and Referrals Ordered in the Cohort

The present study sheds light on the epidemiological and clinical landscape of adolescent gynaecological presentations in a tertiary care setting. Age was found to be significantly associated with the type of presenting complaint (χ² = 16.39, p = 0.037), with mid-adolescents (15–17 years) most commonly presenting with menstrual irregularities and dysmenorrhea. This aligns with previous studies such as Patil et al. (2019), which noted a surge in gynaecological visits during the mid-teen years due to hormonal maturation. When menstrual disorders were analyzed in relation to age, the association was statistically significant (χ² = 12.87, p = 0.044), reinforcing that older adolescents tend to report more complex menstrual complaints like oligomenorrhea and menorrhagia. This corroborates the findings by Kumari (2013) , who emphasized the need for early screening in menstrual health education.

The distribution of clinical diagnoses in our cohort revealed that dysmenorrhea, oligomenorrhea, and menorrhagia dominated the clinical spectrum. This distribution was highly statistically significant (χ² = 28.15, p < 0.001), highlighting a non-random clustering of menstrual disorders. Such trends echo findings by Jain & Modi (2015), who also reported menstrual issues as the leading reason for adolescent gynaecologic consultations.

Clinical examination findings were not only diagnostic but also statistically significant (χ² = 30.62, p < 0.001), with tenderness and vaginal discharge closely following syndromic diagnosis patterns such as pelvic inflammatory disease and infections. These patterns were consistent with observations by Gupta et al. (2016) regarding the diagnostic utility of per-abdominal and per-speculum assessments in adolescents.

Importantly, investigations and referrals also showed a strong statistically significant distribution (χ² = 60.27, p < 0.001), with pelvic ultrasonography and hormonal assays being the most common. This reaffirms the shift towards individualized diagnostic workups for adolescents as suggested in recent research by Katke et al. (2023). Together, these statistically validated findings add empirical weight to clinical observations and support data-driven adolescent gynaecology protocols in tertiary settings.

Limitations

This study, while offering a valuable snapshot of adolescent gynaecologic presentations in a tertiary care setting, is limited by its single-centre design and relatively small sample size. As the data were collected over a six-month period, seasonal and temporal variations in healthcare-seeking behaviour may not be fully captured. Furthermore, the study was observational and relied heavily on clinical records and patient-reported symptoms, which may be influenced by recall bias or underreporting, especially for sensitive concerns like sexual activity or menstrual irregularities. Lack of long-term follow-up also precludes assessment of treatment outcomes and recurrence patterns.

This prospective evaluation highlights that menstrual disorders, particularly dysmenorrhea, oligomenorrhea, and menorrhagia, are the most frequent gynaecological issues among adolescent girls attending outpatient clinics. Polycystic ovarian syndrome and reproductive tract infections are also notable concerns requiring early identification. The findings underscore the importance of age-sensitive, symptom-driven evaluation protocols and the need for structured adolescent-friendly reproductive health services. Routine use of targeted investigations such as ultrasonography and hormonal profiles enhances diagnostic accuracy. Strengthening early gynaecological screening and health education initiatives in this age group may play a pivotal role in addressing both clinical and psychosocial dimensions of adolescent reproductive health.

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