A woman’s menstrual cycle is under the influence of three major organs, the hypothalamus, the pituitary gland and the ovaries which work together as if they are one, hence referred to as the HPO axis, to control the processes involved in ovulation and all other events that occur in the menstrual cycle. In a young girl, prior to puberty, none of the three organs are actively involved in reproduction and all are held under a negative control by the brain. But at the earliest stage of the reproductive career of a young girl who just approached puberty, the hypothalamus begins some skeletal activities, gradually releasing hormones that subsequently drive the menstrual cycles. These early menses are usually devoid of ovulation as the hormonal secretion from the hypothalamus necessary to drive the menstrual cycles are usually inadequate and not strong enough to effect regular ovulation. This continues until a time comes when the hypothalamus become adept in releasing sufficient amount of hormones to drive fully the various events of the menstrual cycle including that of regular ovulation. This seemingly learning curve for the hypothalamus which may take a few years after menarche prior to the occurence of regular ovulation, is often described as immaturity of the HPO axis. Becase this is usually a temporal phenomenom, it normally doesn’t require treatment rather reassurance of both the young girl and her parents, unless in the certain cases where the irregular menses, is associated with excessive or prolonged menstrual bleeding, which may then necessitate the use of either oral contraceptive pills or cyclical progesterone tablets to create a controlled cyclical menstrual bleeding with the aim of preventing anaemia, a complication of excessive menstrual flow. For more information, please read FROM PUBERTY TO MENOPAUSE: A REVIEW OF THE FEMALE REPRODUCTIVE CAREER or take time to CHAT WITH OUR CONSULTANTS.