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The hypothalamic-pituitary-ovarian (HPO) axis is a complex neuroendocrine system that governs menstruation and is sensitive to even small variations in health status. Consequently, regular menstrual cycles generally indicate good health, whereas menstrual abnormalities might be the first clue that something is amiss. Because the HPO axis matures as puberty progresses, what is normal early in puberty might be abnormal a year later. To guide pediatricians in assessing menstrual patterns of teenage girls, the AAP Committee on Adolescence and the Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists prepared a clinical report on menstruation in adolescent females. Highlights of the report include: