Abnormal uterine bleeding and dysfunctional uterine bleeding in pediatric and adolescent gynecology

Abstract

Abnormal uterine bleeding (AUB), which is defined as excessively heavy, prolonged and/or frequent bleeding of uterine origin, is a frequent cause of visits to the Emergency Department and/or health care provider. While there are many etiologies of AUB, the one most likely among otherwise healthy adolescents is dysfunctional uterine bleeding (DUB), which is characterizing any AUB when all possible underlying pathologic causes have been previously excluded. The most common cause of DUB in adolescence is anovulation, which is very frequent in the first 2-3 post-menarchal years and is associated with immaturity of the hypothalamic - pituitary - ovarian axis. Management of AUB is based on the underlying etiology and the severity of the bleeding and primary goals are prevention of complications, such as anemia and reestablishment of regular cyclical bleeding, while the management of DUB can in part be directed by the amount of flow, the degree of associated anemia, as well as patient and family comfort with different treatment modalities. Treatment options for DUB are: combined oral contraceptives (COCs), progestogens, non steroidal anti inflammatory drugs (NSAIDs), tranexamic acid (anti-fibrinolytic), GnRH analogues, Danazol and Levonorgestrel releasing intra uterine system (LNG IUS).

Overview of Abnormal Uterine Bleeding in Adolescents: Diagnosis and Management

“…However, almost all cases of DUB in adolescents are known to originate from anovulatory cycles (12,17). A late first menarche especially increases the possibility of the cycles being anovulatory, as it indicates that gynaecological maturation will also be delayed (6,18).…”

“…A diagnostic evaluation should be performed before any treatment is initiated (6,20). Pathologies such as bleeding disorders, clotting abnormalities, pathology of the reproductive tract, genital injuries and drug use should be excluded in the differential diagnosis process (Table 1).…”

“…Bleeding disorders,which cause 20%-33% of cases of prolonged and/or severe bleeding, should always be taken into consideration (6,20). Continuous bleeding (as leakage) of long durations and occurring beginning with the first menstrual cycle should serve as a warning sign of coagulation disorders (6,22).…”

“…Continuous bleeding (as leakage) of long durations and occurring beginning with the first menstrual cycle should serve as a warning sign of coagulation disorders (6,22). Additionally, patients should be queried as to whether they have a history of recurrent nasal bleeding, easy bruising, symptomatic anaemia or prolonged bleeding after surgery or tooth extraction (22).…”

“…The purpose of this article is to address effects of war and poverty on the health of reproduction of women and to offer scientific contribution and solutions. adolescent AUB is dysfunctional uterine bleeding (DUB) (6).…”