Foreword

Article Outline

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This month's issue of Disease-a-Month addresses menstrual disorders in adolescent females. Greydanus and coauthors do an excellent job of developing a comprehensive review of the subject yet still providing easily accessible guidelines that should be useful to a busy practitioner. Starting with an overview of the physiology, the authors provide extensive background information that can serve as a reference for those practitioners who want detailed information. However, they include clear directions for the busy provider about which patients need further evaluation and treatment recommendations that are easy to follow. For example, treatment for dysfunctional uterine bleeding is broken down into three recommendations based on the level of anemia with specific suggestions and dosing regimens.

Of particular help are the numerous tables, figures, and charts. These provide quick summaries of the material and make it easy for the busy practitioner to pull this issue off the shelf and to quickly access useful information for a patient who is in the office that day. If you are old school and carry a notebook with key information that you want at your fingertips, some of these charts might find their way into that notebook or, for those who embrace more modern technology, into a PDA. While discussing commonly seen problems, the authors also help provide direction for identifying patients with less common or more serious conditions. The authors provide management strategies for these less commonly encountered conditions and give directions about how to use medications that may be less familiar to the primary care provider. One example is their discussion of intranasal desmopressin acetate (DDAVP®) for menorrhagia in patient with Type 1 von Willebrand disease. The discussion of polycystic ovary syndrome provides a cogent description of the pathophysiology and helps explain the rationale behind the diagnosis and treatment of this common but often confusing syndrome.

The final section of the monograph focuses on menstrual disorders such as dysmenorrhea, premenstrual syndrome, and pelvic pain. Again the authors strike a good balance by providing extensive background material yet still retaining value as a useful reference to help with day-to-day management of these problems. I think, as you read this issue, you will agree with me that the authors should be commended for covering a large landscape of material in a thoughtful and useful way.