Adolescent Medicine Menstrual Management Program Expands Access To Patient-Centered Care 

A multidisciplinary approach supporting adolescents with menstrual conditions

Menstrual concerns are among the most common yet often under-addressed health issues affecting adolescents. At Children’s Wisconsin, the Adolescent Medicine Menstrual Management Program provides comprehensive, patient-centered evaluation and treatment for patients experiencing painful, heavy, irregular, absent or medically complex periods. 

The program is part of Adolescent Medicine’s broader reproductive health care offerings and serves patients from menarche through early adulthood for those who continue to receive care within the Children’s Wisconsin system.

A Broad Scope of Menstrual Concerns

Referrals to the Adolescent Medicine Menstrual Management Program span a wide range of concerns. Patients are commonly referred for periods that are painful, heavy, irregular or absent, as well as for menstrual suppression when bleeding is medically inadvisable such
as for those with bleeding disorders or undergoing cancer treatment.

 The team also evaluates and manages menstrual-related conditions such as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), menstrual migraines, catamenial epilepsy, polycystic ovary syndrome (PCOS) and chronic pelvic pain.

Providers are encouraged to refer patients even when menstrual symptoms are not immediately medically concerning but significantly impact quality of life. “These are often issues that significantly disrupt daily life, even when they are not immediately medically dangerous,” said Elizabeth Hovel, MD, Adolescent Medicine Physician at Children’s Wisconsin and Assistant Professor at the Medical College of Wisconsin. “If something about a patient’s periods is bothersome to them, that alone is a reason to refer.” 

Comprehensive Evaluation With Time To Listen

A core pillar of the program is its comprehensive diagnostic approach. Initial visits prioritize a detailed medical and menstrual history and an in-depth discussion of patient priorities and goals. This thorough interview alone can often clarify the underlying cause of symptoms.

When indicated, evaluation may include laboratory testing for endocrine disorders or bleeding conditions, and ultrasound to assess for anatomic causes of menstrual irregularities. 

Individualized, Patient-Centered Treatment

Shared decision making and reproductive justice are foundational to the program’s treatment planning. Care teams focus on understanding what symptoms most affect the patient’s daily life, and which treatment options align with their preferences, values and cultural considerations. Treatment plans are tailored to each patient with an emphasis on improving quality of life. 

Hormonal therapy is the primary treatment method, using a range of options including pills, patches, vaginal rings, shots and long-acting reversible contraceptives. While these therapies are often associated with contraception, they are among the most effective tools for treating menstrual disorders. However, non-hormonal options are available when appropriate.

“We are very intentional about providing unbiased education and ensuring patients and families feel heard,” said Dr. Hovel. “Our role is to help patients choose what works best for them, not to direct them toward a specific method.”

Patients are reassured that treatment plans can evolve over time and that methods, including long-acting options, can be discontinued or changed at any time.

Coordinated Care for Complex Patients

The Adolescent Medicine Menstrual Management Program frequently cares for adolescents with complex medical needs, chronic conditions or developmental disabilities. In these cases, adolescent medicine providers work with primary care clinicians and subspecialists to develop safe, coordinated care plans.

The program also offers multidisciplinary clinics that allow patients to see multiple specialists in a single visit. These include a combined Polycystic Ovary Syndrome Clinic with Endocrinology and the Menorrhagia Clinic with Hematology for patients with heavy menstrual bleeding or bleeding disorders.

In addition, adolescent medicine providers are embedded within oncology and survivorship settings to deliver integrated reproductive health care for patients undergoing, recovering from or thriving after cancer treatment.

Primary care providers remain essential partners in menstrual health care. The adolescent medicine team encourages referrals and consultations, frequently supporting PCPs who resume management once diagnostic evaluation is complete.

“We see this as a partnership,” said Dr. Hovel. “Whether we’re directly managing care or supporting a primary care provider, our goal is to make sure adolescents receive thoughtful, high-quality menstrual health care.”