Menarche is an important event during adolescence. For most girls, it marks successful progression through puberty and the onset of reproductive capability. Confidential and sensitive discussion of growth and development, body image, menstrual function, and sexual behavior is an important component of the annual health examination. Menstrual problems are common during adolescence and frequently require evaluation and intervention. Although most problems are explained by maturation of the hypothalamic-pituitary-ovarian axis, organic pathology must always be considered and excluded in a logical and cost-effective manner.