Abnormal Uterine Bleeding In Adolescents

Abstract

Abnormal uterine bleeding (AUB) is the most common gynecologic complaint of adolescents admitted to hospital. Heavy menstrual bleeding (HMB) is the most frequent clinical presentation of AUB. Anovulatory cycles, owing to immature hypothalamic-pituitary-ovarian axis, is the leading etiology of HMB and there is an accompanying bleeding disorder in almost 20% of patients with HMB. Additionally, endocrine disorders such as hypothyroidism, hyperprolactinemia and polycystic ovary syndrome are possible causes of AUB. Exclusion of bleeding disorders, especially of von Willebrand disease is important for diagnosis and treatment of HMB, particularly in cases with AUB, which has been present since menarche. Management of HMB is based on the underlying etiology and severity of the bleeding. After other causes are excluded, anovulatory heavy bleeding can be treated successfully with combined oral contraceptives and iron supplementation either as an outpatient or in hospital depending on the clinical findings and level of anemia. The epidemiology, clinical presentation, diagnostic approach and treatment of HMB is discussed and our clinical experience in this field is presented in this review.

Abnormal Uterine Bleeding in Adolescents: Current State of the Problem

“…The most severe complications of AUBA are acute blood loss syndrome, which, although infrequent, results in fatalities in somatically healthy girls, as well as anemic syndrome, the severity of which is determined by the intensity of AUB and its duration [27]. Mortality in adolescent girls with AUBA is most often due to acute multiorgan disorders due to severe anemia and hypovolemia, complications of transfusion of native blood and its components, the development of irreversible systemic disorders secondary to chronic iron deficiency.…”

Approach to Abnormal Uterine Bleeding in Adolescents

“…In the presence of a contraindication to estrogen therapy or alternative treatment in adolescents with anemia, progesterone therapy can be an option. Available progesterone therapies are oral medroxyprogesterone acetate (10 mg/day), micronized oral progesterone (200 mg/day) or norethindrone acetate (2.5-5 mg/day), which should be given for 12 days in every cycle (31).…”

Menstrual Disorders

“…Abnormal uterine bleeding (AUB) had many different names prior to 2011 when the International Federation of Gynecology and Obstetrics (FIGO) issued guidance to update and standardize terminology [15]. Terms such as menorrhagia, metrorrhagia, hypo-or hypermenorrhea, polymenorrhea, and dysfunctional uterine bleeding are no longer recommended to be utilized [16]. FIGO recommends the use of the term AUB to describe any change in menstrual volume, frequency, or duration in nonpregnant females [16].…”

“…Terms such as menorrhagia, metrorrhagia, hypo-or hypermenorrhea, polymenorrhea, and dysfunctional uterine bleeding are no longer recommended to be utilized [16]. FIGO recommends the use of the term AUB to describe any change in menstrual volume, frequency, or duration in nonpregnant females [16]. This condition is commonly experienced by approximately 1/3 of reproductive aged women, adds significantly to overall healthcare expenditures, and is welladdressed by family physicians [15].…”