Nichole Tyson MD

All Publications

• Adolescent reproductive health in a post-Dobbs landscape: a review. Current opinion in obstetrics & gynecology Doyle, A. A., Liu, S. M., Tyson, N. A. 2024

  Abstract

  To summarize notable recent research in adolescent reproductive health, particularly with respect to a rapidly changing legal landscape surrounding health services that significantly impact adolescent health.Approval of the first over-the-counter contraceptive pill represented a major advance in adolescent reproductive health, which relied on research regarding its safety, efficacy, and potential to increase access for vulnerable groups. Despite this approval, disparities persist in equitable contraceptive access for adolescents of color and those from sexual and gender identity minorities. Legal changes in access to abortion care and parental involvement in reproductive health decision-making have presented significant challenges for young people across the U.S. Recent research points to the promise of telehealth abortion care and parental acceptance of confidentiality in adolescent reproductive healthcare. Misinformation remains a barrier to advancing adolescent reproductive health and points to continued opportunities for providers to create evidence-based online content.In this review, we discuss recent research regarding adolescent reproductive health and laws impacting the reproductive health of adolescents. As the legal landscape evolves, further research surrounding the effect of policy changes that both expand and restrict access to adolescent reproductive health services will be critical to advancing adolescent health.

  View details for DOI 10.1097/GCO.0000000000000980

  View details for PubMedID 39145493

• Providing adolescent-friendly sexually transmitted infection screening and treatment services. Current opinion in obstetrics & gynecology Friedman, J. C., Cannon, B., Tyson, N., Kang, M. 2024

  Abstract

  There are high rates of sexually transmitted infections (STIs) worldwide. Adolescents and young adults (AYA) ages 15-24 years remain one of the populations that is most vulnerable to STIs. The goal of this review is to summarize recent international updates in adolescent STI screening and treatment.Normalizing sexual history taking and STI testing, and advocating for adolescents to receive comprehensive sexuality education improves stigma surrounding sexual health. The global rise in syphilis is pervasive and includes high rates of infection among AYA and women of reproductive age - universal screening may be indicated depending on local epidemiology. Gonococcal antimicrobial resistance remains a significant public health concern worldwide, thus judicious use of antimicrobials and reporting cases of resistance is crucial. Sexual health services are increasingly using virtual platforms, which may be an effective strategy for STI testing and treatment among AYA.Specific areas of focus to address the STI epidemic among AYA include reducing stigma surrounding sexual health, screening, and treatment of STIs, especially with the global rise in syphilis and high rates of gonorrhea resistance, in addition to increased use of telehealth services as effective education and intervention strategies.

  View details for DOI 10.1097/GCO.0000000000000978

  View details for PubMedID 39109588

• FIGIJ and NASPAG Advocacy Statement Supporting Fertility Preservation for Pediatric and Adolescent Patients Receiving Gonadotoxic Therapy. Journal of pediatric and adolescent gynecology Simms-Cendan, J. S., Jayasinghe, Y., Aguilar, A., Nunzio, C. D., Rome, E., Orti, M., Vatopoulou, A., Drejza, M., Tyson, N., Sumida, M., Romano, M. 2024

  View details for DOI 10.1016/j.jpag.2024.06.001

  View details for PubMedID 38880287

• Contraceptive strategies for reducing the risk of reproductive cancers. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics Aliabadi, A. R., Wilailak, S., McNally, O., Berek, J. S., Sridhar, A., FIGO Committee on Contraception, FIGO Committee on Women's Cancer, Sheffield, J., Kasliwal, A., Musinguzi, J., Gonzalez, C. C., Ahsan, A., Mola, G., Roy, P., Lam, W., Serrano, M. A., Askew, I., Ten Hoope-Bender, P., Tyson, N., Townsend, J., Makins, A., Fuchs-Montgomery, N., Cobley, B., Kehoe, S., Pomerantz, T., Lindeque, G., Anorlu, R., Scambia, G., Okamoto, A., Schmalfeldt, B., Pareja, R., Berek, J., Creutzberg, C., Mutch, D., Matias-Guiu, X., Fotopoulou, C. 2024

  Abstract

  Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low-resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low-cost behavioral interventions to mitigate reproductive cancer risks.

  View details for DOI 10.1002/ijgo.15567

  View details for PubMedID 38725288

• Surgical Considerations in the Management of Adolescent Endometriosis - An Expert Commentary. Journal of minimally invasive gynecology Tyson, N., Shim, J., Lee, T., King, C. R., Md, J. E., Hornstein, M. D., Laufer, M. R. 2024

  Abstract

  Given the complexities and controversies that exist in diagnosing adult endometriosis, as well as optimizing medical and surgical management, it is not surprising that there is even more ambiguity and inconsistency in the optimal surgical care of endometriosis in the adolescent. This collaborative commentary aims to provide evidence-based recommendations optimizing the role of surgical interventions for endometriosis in the adolescent patient with input from experts in minimally invasive gynecologic surgery, pediatric and adolescent gynecology and infertility/reproductive medicine.

  View details for DOI 10.1016/j.jmig.2024.01.021

  View details for PubMedID 38325581

• FIGO position statement on comprehensive sexuality education. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics Koch, M., Tyson, N., Bhuinneain, G. M., Kasliwal, A., Conry, J., Sridhar, A. 2024; 164 (2): 531-535

  Abstract

  Now is a pivotal moment in the fight for reproductive health and justice internationally. Well-established research has recognized the benefits of comprehensive sexuality education for youth and adolescents-including vast reproductive health benefits, decreased interpersonal violence, and improvements on measures of academic success and well-being. Despite these established benefits, challenges to the implementation of culturally sensitive and holistically framed sexuality education are intensifying across the globe. The International Federation of Gynecology and Obstetrics (FIGO) stands firmly in its support of comprehensive sexuality education and re-emphasizes the importance of the implementation of scientifically accurate, age-appropriate, culturally relevant, and inclusive education. Successful implementation relies on active youth leadership, physician involvement, and a renewed focus on high-quality monitoring mechanisms to assess impact and accountability at all levels. Most importantly, future efforts to improve and scale comprehensive sexuality education must emphasize the importance of an inclusive curriculum that addresses previously marginalized youth, such as LGTBQ+ and disabled individuals, through a reproductive justice lens. FIGO commits, and encourages the international healthcare community, to provide continued advocacy for the rights to health, education, and equality, in order to achieve improvement in health outcomes for young people across the globe.

  View details for DOI 10.1002/ijgo.15319

  View details for PubMedID 38219018

• Evaluation and Management of Endometriosis in the Adolescent. Obstetrics and gynecology Shim, J. Y., Laufer, M. R., King, C. R., Lee, T. T., Einarsson, J. I., Tyson, N. 2023

  Abstract

  Endometriosis is a chronic condition, with debilitating symptoms affecting all ages. Dysmenorrhea and pelvic pain often begin in adolescence, affecting school, daily activities, and relationships. Despite the profound burden of endometriosis, many adolescents experience suboptimal management and significant delay in diagnosis. The symptomatology and laparoscopic findings of endometriosis in adolescents are often different than in adults, and the medical and surgical treatments for adolescents may differ from those for adults as well. This Narrative Review summarizes the diagnosis, evaluation, and management of endometriosis in adolescents. Given the unique challenges and complexities associated with diagnosing endometriosis in this age group, it is crucial to maintain a heightened level of suspicion and to remain vigilant for signs and symptoms. By maintaining this lower threshold for consideration, we can ensure timely and accurate diagnosis, enabling early intervention and improved management in our adolescent patients.

  View details for DOI 10.1097/AOG.0000000000005448

  View details for PubMedID 37944153

• Going with the flow: the emergence of menstrual science. BMJ sexual & reproductive health Tyson, N., Kciuk, O., Blumenthal, P. D. 2023

  View details for DOI 10.1136/bmjsrh-2023-201972

  View details for PubMedID 37643875

• An adolescent with adnexal torsion presenting with severe hyponatremia JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Brookhart, C., Kciuk, O., Debiec, K., Smith, C., Tyson, N. 2023; 92

  View details for DOI 10.1016/j.epsc.2023.102613

  View details for Web of Science ID 000956552000001

• Adolescent Contraception The Global Library of Women's Medicine (GLOWM) Tyson, N., Labovsky, M., Oizerovich, S., Liu, S. 2023

  View details for DOI DOI 10.3843/GLOWM.418433

• Corrigendum to “NASPAG Position Statement: Eliminating Period Poverty in Adolescents and Young Adults Living in North America” [Journal of Pediatric and Adolescent Gynecology Journal of Pediatric and Adolescent Gynecology Harrison, M., Davies, S., Tyson, N., et al 2023: 260
• Pediatric Tubal Torsion and Bilateral Hydrosalpinx as Upper Abdominal Masses. Clinical pediatrics Khorshid, A., Tyson, N. A. 2022: 99228221142125

  View details for DOI 10.1177/00099228221142125

  View details for PubMedID 36475328

• Elevating the Needs of Minor Adolescents in a Landscape of Reduced Abortion Access in the United States. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Hoopes, A. J., Maslowsky, J., Baca, M. A., Goldberg, J., Harrison, M. E., Hwang, L. Y., Romano, M., Tebb, K., Tyson, N., Grubb, L. K. 2022

  View details for DOI 10.1016/j.jadohealth.2022.08.007

  View details for PubMedID 36096900

• Pediatric and Adolescent Gynecologic Emergencies. Obstetrics and gynecology clinics of North America Cizek, S. M., Tyson, N. 2022; 49 (3): 521-536

  Abstract

  Diagnosis of gynecologic emergencies in the pediatric and adolescent population requires a high index of suspicion to avoid delayed or incorrect diagnoses. This article aims to dispel common misunderstandings and aid with diagnosis and management of 3 common pediatric and adolescent gynecologic emergencies: adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers.

  View details for DOI 10.1016/j.ogc.2022.02.017

  View details for PubMedID 36122983

• Progestins of today and tomorrow. Current opinion in obstetrics & gynecology Liu, S., Kciuk, O., Frank, M., Tyson, N. 2022

  Abstract

  PURPOSE OF REVIEW: To review the current literature on the multiple types and uses of progestins in reproductive healthcare.RECENT FINDINGS: Progestins for contraceptive use are available in multiple forms, with the ongoing development of transdermal, intravaginal, and male contraception formulations. Noncontraceptive use of progestins often overlaps with contraceptive indications, which allows for simultaneous multipurpose progestin use, especially in reproductive-aged patients. More studies are needed to determine contraceptive doses of progestins used for noncontraceptive purposes. Side effect profiles of progestins are dependent on their formulation and cross-reactivity with other steroid receptors. Development of newer progestins includes manipulating pharmacologic properties to avoid undesired side effects.SUMMARY: Progestins have multiple uses in reproductive healthcare, including contraception, menstrual suppression, endometrial protection, and hormonal replacement therapy. The development of progestins for these indications can expand therapy for people with contraindications to estrogen-based hormonal therapy.

  View details for DOI 10.1097/GCO.0000000000000819

  View details for PubMedID 36036464

• Dobbs v. Jackson Decision: It's Time to Get Uncomfortable. Hospital pediatrics Goldstein, R. L., Carlson, J. L., Tyson, N. A. 2022

  Abstract

  The recently announced decision of the Supreme Court in the Dobbs v. Jackson case has left health care providers, researchers, and administrators struggling to defend reproductive health care against legal restrictions. Although some hospital-based providers may not consider reproductive health care as part of their "wheelhouse," anyone who cares for adolescents and young adults must see this as a call to action. Reproductive health screening is often missed in the primary care setting1 which has led to recommendations to provide this care wherever adolescents and young adults present for care.2 As adolescents are under the legal age of majority and typically have less experience, education, and resources to help them access reproductive health care when needed, these new abortion laws will create disproportionate burdens on the adolescent population. For low-income youth and adolescent and young adults of color, this will likely worsen the disparities that already exist with regard to access to reproductive health care.3 Adolescents have the highest rates of unintended pregnancy4 and these pregnancies are more likely to end in abortion than adult pregnancies.5,6 Adolescents younger than age 20 make up 12% of individuals who have abortions in the US; minors who are 17 years or younger account for about 4% of all abortions in the US.7.

  View details for DOI 10.1542/hpeds.2022-006829

  View details for PubMedID 35799327

• Menstruation: Environmental impact and need for global health equity. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics Harrison, M. E., Tyson, N. 2022

  View details for DOI 10.1002/ijgo.14311

  View details for PubMedID 35781656

• Elevating the Needs of Minor Adolescents in a Landscape of Reduced Abortion Access in the United States Journal of Adolescent Health Hoopes, A., Maslowsky, J., Baca, M., Goldberg, J., Harrison, M., Hwang, L., Romano, M., Tebb, K., Tyson, N., Grubb, L. 2022

  View details for DOI 10.1016/j.jadohealth.2022.08.007

• NASPAG/SAHM Statement: The 21st Century Cures Act and Adolescent Confidentiality. Journal of pediatric and adolescent gynecology Carlson, J., Goldstein, R., Hoover, K., Tyson, N. 2021; 34 (1): 3–5

  View details for DOI 10.1016/j.jpag.2020.12.015

  View details for PubMedID 33485521

• NASPAG/SAHM Statement: The 21st Century Cures Act and Adolescent Confidentiality. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Carlson, J., Goldstein, R., Hoover, K., Tyson, N. 2021; 68 (2): 426–28

  View details for DOI 10.1016/j.jadohealth.2020.10.020

  View details for PubMedID 33541602

• Differential Diagnosis of a Unique Vulvar Mass in an Adolescent. Obstetrics and gynecology Chow, S., Doyle, A., Hammer, P., Tyson, N. A. 2021

  Abstract

  Vulvar masses in adolescents have a broad differential diagnosis, yet few reports exist detailing masses of mammary origin.A nulliparous, healthy 16-year-old adolescent presented with a longstanding, ulcerated, 17-cm vulvar mass of unknown origin and pronounced inguinal lymphadenopathy. The patient underwent a left radical partial vulvectomy, with pathology revealing terminal duct lobular units consistent with polymastia.Differential diagnosis of a vulvar mass in an adolescent should include polymastia.

  View details for DOI 10.1097/AOG.0000000000004563

  View details for PubMedID 34735404

• Subdermal Contraceptive Implant Insertion Trends and Retention in Adolescents. Journal of pediatric and adolescent gynecology Lopez, M., Merchant, M., Postlethwaite, D., Tyson, N. 2020

  Abstract

  PURPOSE: There is growing advocacy for use of long-acting reversible contraception among sexually active adolescents. Our primary aims were to evaluate etonogestrel subdermal contraceptive implant (SCI) insertion trends among adolescents, as well as SCI retention at 1, 2 and 3 years, indications for removal, and to identify pregnancies occurring during SCI use.METHODS: A retrospective cohort study was conducted of adolescents aged 13-19 with SCI insertions in 2008-2014 within a large integrated healthcare system. Demographic and clinical characteristics included age, race/ethnicity, BMI, gravidity, parity, insertions, reinsertions, indications for removal, and pregnancy. Electronic medical record review was conducted on a randomized sample of 540 adolescents with insertions during 2008-2011 for the retention objective to validate electronically extracted variables. Analyses included descriptive statistics, survival analysis with Kaplan-Meier estimates for implant retention and Cochran-Armitage trend test for insertions by year during 2008-2014.RESULTS: Most adolescent SCI users were non-Hispanic White (43%), or Hispanic (34.2%) and 16 years or older (84.2%) at the time of insertion. Overall, 1-, 2- and 3-year retention rates were 78.6%, 59.4% and 26.2% respectively, with retention at 44.3% at 2 years 9 months (indicative of removal of method for near expiration of 3- year device). The insertion rate trend demonstrated statistically significant increases annually, from 0.14% in 2008 to 0.91% in 2014, p< 0.0001. No pregnancies were documented during implant use. The most common indication for SCI removal was device expiration.CONCLUSIONS: SCI insertions increased annually among adolescents, with more than a six-fold increase over the 6-year study period, and over half of the SCIs retained through 2 years of use.

  View details for DOI 10.1016/j.jpag.2020.12.019

  View details for PubMedID 33388444

• A Clinical Approach to Catamenial Epilepsy: A Review. The Permanente journal Frank, S., Tyson, N. A. 2020; 24: 1–3

  Abstract

  IMPORTANCE: Catamenial epilepsy (CE) is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy. There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This article reviews the diagnosis and management of CE for the non-neurologist. Women with CE have early touch points in their care with numerous health care providers before ever consulting with a specialist, including OB/GYNs, pediatricians, emergency department physicians, and family medicine providers. In addition, women affected by CE have seizures that are more recalcitrant to traditional epilepsy treatment regimens. To optimize management in patients affected by CE, menstrual physiology must be understood, individualized hormonal contraception treatment considered, and adjustments and interactions with antiepileptic drugs addressed.OBSERVATIONS: CE is a unique subset of seizure disorders affected by menstrual fluctuations of progesterone and estrogen. The diagnosis of CE has been refined and clarified. There is an ever-increasing understanding of the importance and variety of options of hormonal contraception available to help manage CE. Furthermore, antiepileptic drugs and contraception can interact, so attention must be directed to optimizing both regimens to prevent uncontrolled seizures and pregnancy.CONCLUSION AND RELEVANCE: CE can be diagnosed with charting of menstrual cycles and seizure activity. Hormonal treatments that induce amenorrhea have been shown to reduce CE. Optimizing antiepileptic drug dosing and contraceptive methods also can minimize unplanned pregnancies in women affected by CE.

  View details for DOI 10.7812/TPP/19.145

  View details for PubMedID 33482944

• Provision of Reproductive Health for Teens During a Pandemic J Pediatr Adolesc Gynecol Tyson, N. 2020; 33 (4): 331

  View details for DOI 10.1016/j.jpag.2020.05.003

• Reproductive effects of obesity in adolescents Textbook of Pediatric and Adolescent Gynecology Wellenstein, W., Tyson, N. CRC Press. 2020; second: 256–264.
• Adolescents and long-acting reversible contraceptives: beyond the basics. Current opinion in obstetrics & gynecology Stanton, T. n., Cizek, S. n., Tyson, N. n. 2020

  Abstract

  The current article explores some of the more complex subtopics concerning adolescents and long-acting reversible contraceptives (LARC).Recent research has highlighted ways in which LARC provision can be optimized in adolescents and has identified gaps in adolescent LARC access and utilization.Contraceptive counseling for adolescents should be patient-centered, not necessarily LARC-first, to avoid coercion. There are increasing applications for the noncontraceptive benefits of LARC for several unique patient populations and medical conditions.

  View details for DOI 10.1097/GCO.0000000000000668

  View details for PubMedID 33002953

• A clinical approach to catamenial epilepsy Perm J Frank, S. E., Tyson, N. A. 2020; 24 (19)
• Reproductive Health: Options, Strategies, and Empowerment of Women. Obstetrics and gynecology clinics of North America Tyson, N. A. 2019; 46 (3): 409-430

  Abstract

  Contraception is paramount to the overall health and longevity of women. Most women in the United States use birth control in their reproductive lifetimes. All options should be available and easily accessible to permit individualization and optimization of chosen methods. Current contraceptive methods available in the United States are reviewed. Emergency contraception, contraception in the postpartum period, and strategies to tailor methods to those affected by partner violence are also addressed. Tables and flow charts help providers and patients compare various contraceptive methods, optimize the start of a method, and identify resources for addressing safety in those with underlying medical conditions.

  View details for DOI 10.1016/j.ogc.2019.04.002

  View details for PubMedID 31378285

• Childhood-Onset Eosinophilic Granulomatosis with Polyangiitis with a Vulvar Granuloma: A Case Report and Review of the Literature. Journal of pediatric and adolescent gynecology Swain, C. A., Sherry, T. R., Tyson, N. 2019; 32 (4): 425-428

  Abstract

  Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multisystem necrotizing vasculitis associated with eosinophilia and extravascular granuloma and classically involving the upper and lower airways. There have only been a few reported cases of gynecologic involvement in EGPA.We present an 8-year-old girl diagnosed with EGPA with a vulvar granuloma in what is, to our knowledge, the first reported pediatric gynecologic manifestation of EGPA. Interestingly, the vulvar granuloma did not respond to initial immunosuppressant treatment with prednisone and methotrexate and required treatment regimen modification with mycophenolate mofetil resulting in granuloma resolution.EGPA in the pediatric population has a relatively high mortality rate compared with in the adult population thus it is important that vulvar granulomas associated with EGPA should be included in the differential diagnosis of a vulvar mass allowing for the prompt diagnosis and treatment of this potentially fatal disease in children.

  View details for DOI 10.1016/j.jpag.2019.03.002

  View details for PubMedID 30904627

• Childhood and adolescent obesity definitions as related to BMI, evaluation and management options. Best practice & research. Clinical obstetrics & gynaecology Tyson, N., Frank, M. 2018; 48: 158-164

  Abstract

  In North America, 30% of children are overweight or obese. Child obesity is a precursor to adult health risks. Diagnosis of childhood obesity is difficult. The best measurement is BMI percentile charts. Obesity in children and adolescents can be treated by diet and activity changes. Family involvement in healthy lifestyle changes is best for weight loss and prevention.

  View details for DOI 10.1016/j.bpobgyn.2017.06.003

  View details for PubMedID 28838829

• HPV Update. Journal of pediatric and adolescent gynecology Tyson, N. 2017; 30 (2): 262-264

  View details for DOI 10.1016/j.jpag.2016.10.009

  View details for PubMedID 27989918

• Laparoscopic Myomectomy of a Symptomatic Uterine Leiomyoma in a 15-Year-Old Adolescent. Journal of pediatric and adolescent gynecology Salehi, P. P., Tyson, N. 2016; 29 (6): e87-e90

  Abstract

  Although adnexal masses and ovarian torsion are common causes of acute pain in the female adolescent, fibroids are an uncommon etiology and little is reported in the literature. Because of the rarity of adolescent leiomyomas, the best surgical management is still unknown.To our knowledge, this is the first case report of a laparoscopic myomectomy in the adolescent population. The removed fibroid is one of the largest documented cases of uterine leiomyoma in adolescents.Degenerative fibroids, albeit less common, should be kept on the differential diagnosis, as a possible cause of pelvic mass and pain in the adolescent population. Fibroids in the adolescent patient, like the adult, can be managed with minimally invasive surgery with excellent clinical outcomes.

  View details for DOI 10.1016/j.jpag.2016.05.007

  View details for PubMedID 27262836

• Committee Opinion No 672: Clinical Challenges of Long-Acting Reversible Contraceptive Methods. Obstetrics and gynecology 2016; 128 (3): e69-77

  Abstract

  Long-acting reversible contraceptive methods are the most effective reversible contraceptives and have an excellent safety record. Although uncommon, possible long-acting reversible contraceptive complications should be included in the informed consent process. Obstetrician-gynecologists and other gynecologic care providers should understand the diagnosis and management of common clinical challenges. The American College of Obstetricians and Gynecologists recommends the algorithms included in this document for management of the most common clinical challenges.

  View details for DOI 10.1097/AOG.0000000000001644

  View details for PubMedID 27548557

• Contraception Adolescent Medicine Today A Guide to Caring for the Adolescent Patient Tyson, N., Simpson, E., Berlan, E. 2011: 233–253
• Care of the overweight adolescent including polycystic ovarian syndrome. Clinical obstetrics and gynecology Zidenberg, N., Wright, S. 2008; 51 (2): 249-56

  Abstract

  Obstetrician-gynecologists are responsible for promoting healthy eating and physical activity in adolescents during annual screening examinations. Adolescents with a body mass index for age greater than or equal to the 95th percentile should undergo an in-depth health assessment to determine psychosocial morbidity and risk of cardiovascular disease. Further research is needed to determine the most efficacious approach to the prevention and treatment of obesity in adolescents. For now, it is best to extrapolate an approach from data pertaining to children and adults, while being cognizant of the special psychosocial and physical needs of adolescents.

  View details for DOI 10.1097/GRF.0b013e31816d2282

  View details for PubMedID 18463456

• Breast Disorders in Females Adolescent Medicine: the Requisites in Pediatrics Huppert, J., Tyson, N. Mosby Inc. 2008: 146–151