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The onset of menstruation in young women is a milestone with personal, cultural, and medical ramifications. Menarche heralds the onset of fertility, which can be cause for both celebration and trepidation for the patient, her family, and clinicians. It behooves both general and specialist pediatricians to be comfortable discussing what is normal and what is not normal about menstruation. Young women who have special health-care needs and their families deserve particular attention. Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage pediatricians to think of menstruation as a “vital sign” for women. (1)(2) Irregular, absent, or overly painful periods should be evaluated, closely monitored, and managed proactively.

In both the evaluation and treatment of menstrual disorders, it is critical to keep in mind the patient’s perspective on her symptoms. It is...

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