2023 Theses Master's

Barriers to using the Menstrual Cycle as a Preventative and Diagnostic Tool in Adolescent Primary Care Settings

Beermann, Brooke

Abnormal symptoms and irregularities of the menstrual cycle can be indicative of broader health disorders throughout the body, including those of endocrine, blood, or gynecologic pathologies. Complete menstrual history taking among adolescents in a primary care environment is a necessary tool to assess overall health during pivotal growth and development years. Additionally, delayed or missed diagnoses in adolescence can have long-term effects throughout the lifespan, including fertility difficulties, reduced bone health, and psychosocial effects. This review sought to investigate barriers to menstrual history documentation among adolescents by providers in the United States using an antecedent-structure-process-outcome model. PubMed and Web of Science were searched for peer-reviewed articles and gray literature relating to menstrual history documentation among adolescents. Broad findings suggest that several factors influence menstrual history taking (1) patient demographics and initial access to well child visits (2) provider gender, training, time, and specialty and (3) variability in menstrual history definitions, health professional obtaining the information, and electronic health records. Early and accurate diagnoses, positive menarche and menstruation experiences, and timely treatments improve reproductive, gynecologic, and overall health outcomes into adulthood. Therefore, pediatric-facing professionals including physicians, advanced practice providers, and ancillary staff must prioritize thorough and standardized menstrual history taking. Further research should explore a qualitative approach to explore provider barriers, as well as expand the diversity of participant demographics to those with earlier menarche, those living in rural regions, and those being served by small private practices. Additionally, research must investigate interventions to improve adherence to menstrual history taking, particularly the inclusion of menstruation questions in a pre-visit questionnaire prior to well-child visits.