搜索结果：Journal of pediatric and adolescent gynecology

To assess resident physician comfort regarding menstrual suppression in gender diverse adolescents (GDA). Secondly, to explore perceived barriers to managing menstrual suppression in GDA. This is an IRB-approved survey study of Family Medicine (FM), Pediatrics, and Obstetrics and Gynecology (OBGYN) residents from all ACGME-accredited programs. Participants completed a survey evaluating their comfort managing: (1) a cisgender adolescent desiring contraception; (2) a cisgender adolescent with dysmenorrhea; and (3) a GDA desiring menstrual suppression. Participants selected their top 3 barriers for each case. A total of 375 participants consented to the survey, and 293 (78%) participants completed the survey. Of the total, 169 (45%) were FM residents, 99 (26%) were Pediatrics residents, and 62 (17%) were OBGYN residents. The majority of FM, Pediatrics, and OBGYN residents were comfortable managing contraception and menstrual concerns in cisgender patients, while 29% of FM residents, 27% of Pediatrics residents, and 50% of OBGYN residents were comfortable managing menstrual suppression in GDA. OBGYN residents were significantly more likely to report comfort managing menstrual suppression in GDA compared to FM (OR 2.44, 95% CI [1.35, 4.45], p = .003) and Pediatrics (OR 2.64, 95% CI [1.37, 5.15], p = .004). All 3 specialties selected lack of education/experience as the top barrier in caring for GDA. FM, Pediatrics, and OBGYN residents indicated comfort managing contraception and menstrual concerns, yet all residents, especially FM and Pediatrics residents, reported discomfort in managing menstrual suppression in GDA. Efforts should focus on enhancing education on caring for gender diverse patients in all 3 residency programs.

Pediatric and adolescent patients face barriers to accessing comprehensive reproductive health care. These barriers are intensified by limited infrastructure and confidentiality regulations that make scheduling, follow-up, and communication more challenging. A patient navigator (PN) position was implemented within a newly established Pediatric and Adolescent Gynecology (PAG) clinic in a large urban medical center to improve access and support confidential care. This study evaluated the impact of the PN on PAG health care utilization and investigated the effects across racial and ethnic groups and insurance types. A retrospective cohort study was conducted using electronic medical record data from Epic SlicerDicer. Health care utilization metrics were compared for 1 year before (March 3, 2023-March 3, 2024) and 1 year after (March 4, 2024-March 4, 2025) the implementation of the PN position. After PN implementation, total appointments increased by 39% (P < .001), completed follow-up visits increased by 65% (P < .001), and the missed appointment rate decreased by 44% (P < .001). Patients who self-identified as Asian experienced a 66% decline in missed appointment rates (P = .031), those who selected "Other" had a 49% decrease (P = .003), and the "Unknown/Declined" racial group saw a 57% decrease (P = .041). Additionally, patients with public insurance saw a 49% (P < .001) decrease. Establishing a PN in a PAG clinic improves utilization of care, continuity, and appointment adherence. We observed significant reductions in the missed appointment rate among several racial and ethnic groups and in the underrepresented group of patients with public insurance.

The purpose of this article is to provide a comprehensive review of recent literature addressing diagnoses and conditions that intersect pediatric and adolescent gynecology (PAG) and complex benign gynecology (CBG) to inform which patients should make the transition from PAG to CBG care, as well as when and how that transition should occur. Recent literature lacks data on formalized transition processes for pediatric gynecology patients who require ongoing management of benign conditions, including, but not limited to, disorders of sexual development, endometriosis, abnormal uterine bleeding, and chronic pelvic pain. CBG specialists are well positioned to assume care for many of these individuals. Evidence suggests that delays in diagnosing conditions like endometriosis and failure to refer to appropriate subspecialists are linked to disease progression and worse long-term outcomes, underscoring the need for timely referral. Transition from PAG to CBG care is a critical juncture for patients with chronic and surgically complex conditions. Structured referrals, clear communication, and multidisciplinary collaboration are key to maintaining continuity of care, preserving fertility, and optimizing outcomes. Given the lack of standardized transition frameworks in gynecology, further research is needed to develop evidence-based protocols and reduce care fragmentation.

The current approach to contraception care is largely trial-and-error based. Approximately 40% of patients discontinue their chosen contraceptive method within the first year of use due to unfavorable side effects. We aimed to: 1) describe healthcare burden experienced by adolescents during contraceptive trials ("trial burden"), and 2) identify sociodemographic factors that modify trial burden experienced by adolescents and clinicians. We conducted a retrospective chart review of 100 adolescents initiating contraception at a tertiary care pediatric and adolescent gynecology clinic from 2021-2023. Sociodemographic data were collected. The primary outcome was contraceptive trial burden, defined as number of contraceptive trials, number of contraception-related outpatient visits, and duration of each trial. Secondary outcomes included prescription of secondary medication for side effect management, emergency room (ER) utilization, and unintended pregnancy. Pearson correlation and ANOVA tests were performed. Mean age at contraception initiation was 15.4 &#xb1; 1.7 years. Adolescents required 2.2 &#xb1; 1.3 contraceptive trials over 19.3 &#xb1; 21.3 months, spanning over 6.3 &#xb1; 4.1 outpatient clinic visits prior to initiation of a final contraceptive method. Thirty-one percent required secondary medication for side effect management. Five adolescents presented to the ER for contraception-related complications. Four adolescents experienced unintended pregnancy during their contraceptive trials. Spanish-speaking adolescents attended more contraception-related outpatient visits and were more likely to require ER care. Trial-and-error contraceptive prescribing in adolescents is associated with significant and avoidable healthcare utilization. Study findings highlight inefficiencies in current contraceptive prescribing practices and the need for clinical tools that will assist with contraception selection, thereby streamlining contraception care and reducing healthcare burden for patients and providers.

The stigma perceived by adolescent and young mothers negatively affects their health and that of their children. This study aimed to identify the factors that influence the stigma perceived by adolescent and young mothers. A cross-sectional survey was conducted with 247 South Korean adolescent and young mothers aged &#x2264;24 years, all of whom had given birth and were caring for their children. Data were collected between January 2024 and March 2024 and analyzed using multiple regression. The mean age of the participants was 22.16 &#xb1; 1.80 years. Social support, place of residence, and knowledge of contraception were significantly associated with perceived stigma. The regression model was significant (F = 16.97, p < .001; adjusted R&#xb2; = 0.34). Social support was negatively associated with stigma (&#x3b2; = -0.27, 95% CI [-0.56, -0.23]), while residing in a parent-owned home increased stigma (&#x3b2; = 0.30, 95% CI [3.72, 8.24]). Knowledge about contraception also reduced stigma (&#x3b2; = -0.18, 95% CI [-6.29, -1.51]). Social support was a key protective factor against perceived stigma among South Korean adolescent and young mothers. For clinicians caring for adolescents and young mothers, these findings highlight the importance of nonjudgmental care, assessment of social support, and accessible contraceptive counseling. Although conducted in South Korea, this study may serve as a model for future studies examining stigma among adolescent and young mothers in other settings.

To investigate the risk of eating disorders, poor sleep quality, and low self-esteem in adolescents with polycystic ovary syndrome (PCOS) in comparison with a healthy group and to determine how these factors are related to each other as well as which disease characteristics may influence them. The study group consisted of adolescents aged 13-21 who were diagnosed with PCOS based on current international suggestions. The control group comprised age-matched healthy volunteer adolescents. All participants completed three standardized self-report questionnaires: The Eating Attitudes Test (EAT-26), the Pittsburgh Sleep Quality Index (PSQI), and the Rosenberg Self-Esteem Scale. A total of 90 adolescents with PCOS and 110 age-matched healthy peers were recruited. The adolescents with PCOS showed a higher risk of eating disorders (23.3% vs 12.7%, P = .048) and low self-esteem (28.9% vs 15.4%, P = .021) compared to their healthy peers. There were no significant differences between two groups in terms of PSQI total score (P > .05). In adolescents with PCOS who were at risk for eating disorders, self-esteem was lower (P = .033), and the rate of poor sleep quality was higher (P = .033). No relationship was found between body mass index or hirsutism and the risk of eating disorders, self-esteem, and sleep quality. The findings of this study suggest that adolescents with PCOS are more likely to experience disturbances in eating attitudes and report low self-esteem. Physicians should be aware of and screen for these psychological and behavioral consequences of PCOS on adolescents.

To evaluate the association between depression and suicidal ideation (SI) screening results among patients in a pediatric and adolescent gynecology clinic and to determine whether associations differ between school and summer periods. This retrospective cross-sectional study included patients aged &#x2265; 13 years who completed both the Patient Health Questionnaire-2 (PHQ-2) and Ask Suicide Screening Questions (ASQ) from June 2023 to April 2025. Depression was defined as a PHQ-2 score &#x2265; 3; SI was defined as any affirmative ASQ response. Simultaneous positive/negative combinations were evaluated, and associations were tested using chi-square or Fisher's exact tests. Among 1,481 patients, PHQ-2 and ASQ scores were significantly associated (p < 0.0001). Negative PHQ-2 screens corresponded to negative ASQ screens in 1,192 (92.5%) patients. However, 97 (7.5%) patients screened negative for depression but positive for SI, including one (0.1%) with severe SI. Positive ASQ screens were more frequently associated with positive PHQ-2 screens (40.6%) than negative PHQ-2 screens (7.5%). All severe ASQ scores occurred during the school year. Screening for depression alone is insufficient to identify all adolescents at risk for suicidality. Dual screening with PHQ-2 and ASQ enables more comprehensive identification of at-risk patients in pediatric and adolescent gynecology settings, thereby enabling practitioners to connect such patients with the necessary mental-health resources.

Polycystic ovary syndrome in adolescence is a condition associated with long-term cardiovascular, metabolic, and psychological outcomes. The diagnosis of PCOS in adolescence poses diagnostic challenges for obstetricians and gynecologists due to pubertal variability and the use of criteria distinct from adult standards. Inter-clinician variability and the role of large language models (LLMs) in this context remain insufficiently explored. This study evaluated guideline adherence among physicians and LLMs using a vignette-based design. Ten guideline-based adolescent PCOS vignettes (ESHRE/ASRM 2023), validated by three obstetrics and gynecology specialists, were administered to obstetricians and gynecologists in T&#xfc;rkiye (n=150). The same vignettes were presented to four LLMs (ChatGPT-5.2, Gemini 3 Flash, Grok 4, DeepSeek V3.2) via a standardized prompt using two independent user accounts in standard and reasoning modes. Inter-account consistency was assessed using accounts. Physicians achieved a mean of 5.0 &#xb1; 1.9 correct responses out of 10 vignettes (each scored as 1 point), whereas large language models demonstrated significantly higher performance (7.6 &#xb1; 1.1; p < 0.001. Physicians with national assisted reproductive technology certification achieved higher scores in difficult cases. Inter-rater agreement among physicians was low (&#x3ba;=0.127, &#x3ba;=0.032, &#x3ba;=0.027). ChatGPT-5.2 (reasoning mode) and Gemini 3 Flash (standard mode) showed high inter-account agreement (p<0.001). Reasoning mode increased overall LLM accuracy. Significant inter-clinician guideline discordance was observed in adolescent PCOS diagnosis. Strengthening this domain is critical for adolescent health. Given their non-deterministic and evolving architectures, LLMs should be positioned as adjunctive tools supporting clinical judgment rather than as independent guideline authorities.

To assess serum betatrophin levels in normal-weight and overweight adolescents with polycystic ovary syndrome and examine associations with anthropometric, hormonal, and metabolic parameters, including insulin resistance. This cross-sectional study included 90 adolescent females (16-23 years); overweight polycystic ovary syndrome (n=30), normal-weight polycystic ovary syndrome (n=30), and age-matched healthy controls (n=30). Anthropometric measurements, hormonal profiles, fasting glucose and insulin, homeostasis model assessment of insulin resistance, inflammatory markers, lipid parameters, and serum betatrophin concentrations were assessed. Multivariable logistic regression identified independent predictors of elevated betatrophin. Associations between betatrophin levels and polycystic ovary syndrome status, adiposity, insulin resistance, and metabolic parameters were analyzed. Serum betatrophin levels differed significantly among groups (p=0.010) and were higher in overweight polycystic ovary syndrome compared with controls (p=0.002). Betatrophin positively correlated with body mass index (r=0.267, p=0.009), homeostasis model assessment of insulin resistance (r=0.463, p<0.001), and estradiol (r=0.378, p=0.001). Multivariable regression identified overweight status as an independent predictor of elevated betatrophin (OR=6.71, 95% CI: 1.23-36.50, p=0.028), whereas insulin resistance showed an inverse association (OR=0.09, 95% CI: 0.02-0.50, p=0.006). Polycystic ovary syndrome status and C-reactive protein were not independently associated. Betatrophin levels are elevated in overweight adolescents with polycystic ovary syndrome and correlate with adiposity and insulin resistance, suggesting its potential as a marker of early metabolic dysfunction.

Pediatric and adolescent gynecology (PAG) is a growing specialty, but despite the complexity of many patients' experiences, few hospitals employ dedicated social workers trained to support these patients and their families. This is true despite the fact that PAG providers routinely care for individuals with multiple conditions where patients and families could benefit from support around long-term implications for reproductive health and fertility; surgical decision making; counseling in the wake of sexual trauma; comprehensive sex education and counseling; and referrals to other social services. This commentary is designed to provide examples of the types of care that can benefit from the involvement of a skilled, experienced behavioral health practitioner as well as potential barriers to hiring a social worker for a multidisciplinary team. There is a need for leaders in PAG to make a multipronged effort to increase training and networking opportunities in PAG social work alongside negotiating increased funding for social care in the PAG setting. This commentary is designed to provide suggestions for a pathway forward.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and a leading cause of cervical, anal, and oropharyngeal cancers. Despite effectiveness in cancer prevention, HPV vaccination rates remain suboptimal. This study examines HPV vaccination initiation and completion among adolescents and young adults across clinic types, demographics, and social determinants of health (SDOH) to identify barriers and inform interventions. We conducted a retrospective cross-sectional analysis using electronic health record data from adolescent medicine, pediatric infectious diseases, internal medicine-pediatrics, and family medicine clinics in the University of South Florida health system and an affiliated community youth sexual health clinic. The study included 456 patients aged 16-24 seen from January to March 2025. HPV vaccination initiation and completion were assessed across clinic types, demographics, and SDOH using descriptive, univariate, bivariate, and multivariate analyses. Overall, 390 patients initiated and 354 completed the HPV vaccination series across 20 clinics. Initiation rates were comparable across clinic types, but completion differed significantly by setting. Completion was independently associated with having insurance, an established primary care provider, completion of other routine vaccines, comorbidities, and female gender. Clinic type was not an independent predictor after adjusting for patient-level factors. HPV vaccination rates in this cohort exceeded national averages, with strong initiation but lower completion, particularly among uninsured patients and those without primary care access. These findings underscore that vaccination outcomes are shaped more by patients' social and structural circumstances than by clinic setting alone, highlighting the importance of contextualizing completion rates accordingly. Targeted system-level interventions are needed to improve series completion and reduce future HPV-related cancer disparities.

Heavy menstrual bleeding (HMB) is a common complaint in young women in the general population and is associated with disruptions in physical, mental, and social well-being. This study aimed to describe the prevalence of HMB among adolescents with Mullerian anomalies. We conducted a retrospective cohort study of adolescents diagnosed with a Mullerian anomaly at a tertiary children's health system from 2014 to 2024. We queried the Electronic Health Record for the following diagnostic codes: Mullerian anomaly, uterine anomaly, bicornuate uterus, didelphic uterus, uterine septum, unicornuate uterus, and arcuate uterus. We defined HMB as provider diagnosis of HMB, menorrhagia, or prolonged menstrual bleeding. We collected data on patient race, age of menarche, age at time of diagnosis of Mullerian anomaly and HMB, subtype of Mullerian anomaly diagnosis, imaging modality used in diagnosis, presence or absence of a bleeding disorder evaluation, and treatment received for HMB. Only adolescents with a confirmed Mullerian anomaly and a documented menstrual history who had reached menarche were included in the analysis. Of the 140 adolescents included, 60 (43%) experienced HMB. HMB was most prevalent in those with bicornuate uterus (58%), uterine septum (55%), and arcuate uterus (50%). The most common treatment for HMB was combined hormonal contraception (44%). The prevalence of HMB in adolescents with Mullerian anomalies in this cohort was 43% but varied by subtype. Understanding the prevalence of HMB in patients with specific Mullerian anomalies will allow clinicians to provide improved anticipatory guidance for this patient population.

Vaginal self-care and vulvovaginal health trends are frequently viewed by adolescent and young adults (AYA) on social media. This study explored AYA understanding, attitudes, knowledge, and practices regarding vulvovaginal health with a focus on the positive and negative influences of social media. We recruited AYA using a criteria based purposeful sample from an urban practice. Semi-structured qualitative interviews explored attitudes, practices, and social media use related to vulvovaginal health. Interviews were recorded, transcribed, coded and thematically analyzed using inductive and deductive methods. 28 participants assigned female at birth (range 15-25 years) were interviewed. Four major themes were identified: (1) Vulvovaginal health is viewed as important and often overlooked; (2) AYA engage in vulvovaginal health practices, such as daily vulvar washing with water or gentle soap, shaving, and explored products like wipes, washes, and vajaycials; (3) AYA view vulvovaginal health content on social media and express diverse attitudes toward products and practices; (4) AYA trust healthcare providers as reliable sources of guidance, with older AYA expressing greater skepticism toward social media. AYA trust healthcare providers as reliable sources of guidance. A subtheme suggested that older participants feel particularly cautious about social media content. Several recommendations emerged for effective communication. Social media is a popular source of vulvovaginal health information. Older AYA Some participants questioned the credibility of content, while also appreciating raised awareness of vaginal health on these platforms. Health care providers should be aware of misinformation and provide evidence based guidance.

Period poverty remains a critical yet underrecognized barrier to adolescent girls' education, health, and psychosocial well-being. This review synthesizes current evidence on the educational, reproductive health, and psychosocial implications of period poverty among secondary school girls. A narrative literature review was conducted using peer-reviewed articles and institutional reports published between 2015 and 2025. Studies examining menstrual hygiene management, access to menstrual products, school participation, reproductive health outcomes, and psychosocial impacts among adolescent girls were included. Thematic analysis was used to synthesize findings across settings. Period poverty was consistently associated with school absenteeism, reduced classroom engagement, and poorer academic performance. Inadequate access to menstrual products and water, sanitation, and hygiene (WASH) facilities contributed to increased risks of reproductive and urinary tract infections. Psychosocial consequences included shame, anxiety, low self-esteem, and depressive symptoms, exacerbated by stigma and cultural taboos. Structural determinants, including poverty, weak school infrastructure, limited parental education, and policy gaps were key drivers. School-based interventions, community engagement, and health system involvement emerged as effective mitigation strategies. Period poverty significantly undermines adolescents' educational attainment, health, and dignity. Multisectoral strategies integrating education, health services, WASH infrastructure, and community-based interventions are essential to promote menstrual equity and adolescent well-being. Addressing period poverty is fundamental to advancing gender equity and achieving global development goals.

To describe university students' lifetime prevalence of inappropriate, disrespectful, and coercive (IDC) experiences during sensitive physical exams and explore differences across sexual orientation and gender identities (SOGI). This cross-sectional study analyzed survey data from a representative sample of students at a large public university (US, 2021, N = 2779). Lifetime prevalence of 13 IDC experiences (eg, painful exams, ungloved exams, attempts to sexually arouse patient) and trust in sensitive exam providers was estimated for the sample and within SOGI groups (gender minority (GM), sexual minority cisgender female/male, heterosexual cisgender female/male). Item prevalence and SOGI associations were assessed with 2-sided t tests and X2 tests. Lifetime prevalence of sensitive exam IDC experiences ranged from 0.6% (took pictures of patient's body without permission) and 2.5% (genital, pelvic, or rectal exam without gloves) to 19.9% (excessive wait while undressed). Significant associations (P < .05) between SOGI and negative experience prevalence estimates were identified; GM students reported the highest prevalence, and cisgender heterosexual male students the lowest, for all but 1 IDC item. 7.9% of students reported not trusting any healthcare providers during sensitive exams, with 30.9% of GM students compared to 3.1% of heterosexual cisgender men reporting no trust (P < .001). GM university students experienced more IDC experiences during sensitive exams and have lower trust in sensitive exam providers than cisgender students, particularly cisgender heterosexual males. Ensuring informed consent, offering chaperones, and clear communication are critical to build trust and ensure continued healthcare engagement and positive long-term health outcomes, particularly for SOGI patients.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed to adolescents for obesity and type 2 diabetes mellitus (T2DM), with growing interest in extending their use to conditions such as polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome or PCOS). However, adolescence represents the critical window for peak bone mass acquisition, and the implications of pharmacologic weight loss during this developmental period have received limited attention. Furthermore, this commentary addresses potential concerns related to eating disorder risk and future reproductive outcomes in this population. This commentary examines the emerging concerns regarding bone health, reproductive safety, eating disorder risk and endocrine development when GLP-1 RAs are used in adolescent populations. Adult studies demonstrate improvements in weight loss, insulin resistance, and menstrual regularity with GLP-1 RA therapy. In adolescents with obesity, clinical trials of liraglutide and semaglutide show significant weight reduction without short-term effects on growth or pubertal development. However, adolescence represents a critical period for peak bone mass acquisition, and rapid pharmacologic weight loss may theoretically impair bone mineral accrual. Evidence from adult populations suggests modest reductions in bone mineral density associated with weight loss, while structured exercise may mitigate these effects. GLP-1 RAs are not recommended during pregnancy, and no data exist on reproductive outcomes following adolescent exposure. Additionally, the potent appetite-suppressing effects of these agents raise concerns about potential misuse or exacerbation of eating disorders in adolescents, a population uniquely vulnerable to body image pressures. GLP-1 RAs represent a promising adjunct therapy for adolescents with obesity, T2DM, and PMOS, but long-term skeletal, reproductive, psychological, and endocrine outcomes remain uncertain. Careful patient selection, bone health monitoring, incorporation of resistance exercise, contraceptive counseling, and screening for disordered eating may be essential when these therapies are considered in adolescent populations.

This study aims to retrospectively assess outcomes, including intrauterine device (IUD) continuation, repeat pregnancy, and complication rates, of immediate postplacental levonorgestrel 52 mg IUD (PPIUD) placement in obstetric patients aged 21 and under at a high-volume county hospital. We retrospectively reviewed charts of patients who received a PPIUD between March 1, 2021, and August 15, 2022, at our institution. The primary outcome was continued IUD use. Secondary outcomes were repeat pregnancy, reason for IUD discontinuation, including complete and partial expulsion, pelvic infection, and string complications (strings lost or trimmed). A total of 285 patients with a mean age of 19 years (range 14-21) had a PPIUD placed. Electronic medical record data was collected retrospectively through 8/31/23 to ensure follow-up for at least 1 year following IUD placement or until repeat pregnancy, whichever came first; the median length of data collection after initial IUD placement was 20 months (range 2-30 months). There was continued IUD use in 197 (69.1%). IUD expulsion was the most common reason for discontinuation and occurred in 32 patients; overall expulsion rate was 15.4%. Repeat pregnancy occurred in 25 (8.8%) patients, all of whom had IUD removal or expulsion. No pelvic infections occurred. Strings were not visualized in 63 (21.9%) patients and trimmed in 24 (8.3%). Immediate PPIUD placement in adolescents and young adults results in high continuation and low repeat pregnancy rates in this population. Expulsion and infection rates were comparable to prior studies. Patients should be counseled on potential PPIUD string complications.

Emergency departments (EDs) provide a critical access point for adolescents with unmet sexual and reproductive health (SRH) needs; yet, effective connection to follow-up care remains limited. This study aimed to develop and pilot test the Dr. Erica Digital Referral Tool (Dr. E-DRT), a patient-facing tool designed to educate adolescent females and facilitate linkage to person-centered sexual healthcare after ED discharge. We conducted a prospective cohort study from July 2023 to February 2024 in an urban pediatric ED. Biologically female, English-speaking adolescents aged 14-19 years were screened for eligibility. Enrolled participants completed a baseline survey, interacted with the Dr.E-DRT and were offered the option to schedule a follow-up appointment for SRH care. Two-month follow-up was completed via survey and electronic medical record (EMR) review. Outcomes included feasibility, acceptability, and potential efficacy to increase outpatient follow-up. Of 223 adolescents screened, 31 met eligibility criteria and 25 enrolled. All participants completed the tool and 16 participants (64%) scheduled a follow-up visit at our local family planning practice. Acceptability of Dr. E-DRT was high across multiple dimensions, with mean Likert scores ranging from 4.2 to 4.4 out of 5 for satisfaction, appeal, and likelihood of recommending the tool. At 2-month follow-up, survey completion was 40% (10/25). Only 3 participants attended the follow-up visit. Dr.E-DRT was feasible to implement and well accepted by adolescents in the ED. While appointment scheduling was high, visit completion remained low, highlighting the need for additional strategies to support linkage to SRH care after ED visit.

Although menstrual disorders are frequent in adolescent girls, limited data exist regarding their occurrence and characteristics in patients with juvenile idiopathic arthritis (JIA). This study aimed to determine the frequency of menstrual problems, premenstrual syndrome (PMS), and dysmenorrhea-related coping skills in adolescents with JIA, and to examine their potential associations with disease-related parameters, treatment, and quality of life (QoL). This cross-sectional study included 51 adolescents with JIA and 56 age- and BMI-matched healthy controls (HC) recruited from pediatric rheumatology and adolescent health clinics. Menstrual characteristics, PMS, and dysmenorrhea were assessed using structured questionnaires, the Premenstrual Syndrome Scale, and the Adolescent Dysmenorrhea Self-Care Scale (ADSCS). QoL was measured by the Pediatric Quality of Life Inventory (PedsQL). Disease-related data, treatment history, and laboratory findings were obtained from medical records. The age at menarche was significantly later in the JIA group than in HC (13 vs. 12 years, p&#x202f;=&#x202f;0.001). Dysmenorrhea was common in both groups (74.5% vs. 89.2%, p&#x202f;=&#x202f;0.046) but coping scores were lower in the JIA group (79 vs. 99, p&#x202f;=&#x202f;0.004). PMS frequency was lower in JIA (39.2% vs. 57.1%, p&#x202f;=&#x202f;0.064), and total PMS scores were significantly reduced (102 vs. 118.5, p&#x202f;=&#x202f;0.005). No associations were found between menstrual problems and disease activity, steroid dose, or methotrexat/biologic use. Adolescents with JIA experience frequent menstrual problems and delayed menarche. During routine pediatric rheumatology visits, adolescent girls' menstrual history should be systematically assessed, and those with significant or troubling gynecological problems should be referred appropriately.