Abnormal uterine bleeding in adolescents: modern views of the problem

Abstract

The current analytical literature review examines modern views on the development of menstrual function, evaluation of the menstrual cycle, diagnosis, treatment and prevention of abnormal uterine bleeding (AUB) in adolescents, because this bleeding is the most common gynecological complaint in adolescent girls.The aim of this review was to identify differences in the diagnosis, monitoring and treatment of adolescent patients depending on the severity of menstrual bleeding. For this purpose, a literature search and analysis was conducted in the PubMed scientometric database for the past 20 years regarding the incidence, etiology, diagnosis, and clinical management of pubertal vaginal bleeding.AUB is a common problem that negatively affects a girl’s quality of life, and can also indicate the presence of a pathology that is forming or has already developed. The main cause of AUB in adolescence is anovulation, but pregnancy, bleeding from the rectum or urethra, the presence of a foreign body, trauma, and sexually transmitted diseases must also be excluded during the examination, regardless of history.It is ought to pay attention that it can be difficult for teenagers to visit a doctor or access services for problems related to the menstrual cycle. Therefore, pubertal bleeding requires not only a multidisciplinary and pro-proliferative approach, but also affordable management.Watchful waiting and observation are sufficient management options for mild AUB, but, on the other hand, life-threatening bleeding may require the use of high-dose combined oral contraceptives, progestins, intravenous estrogen, and/or interventional procedures.A thorough history and clinical examination to identify possible causes and associated risk factors can help identify causes of AUB that do not warrant further investigation and alternative diagnoses that require specific treatment and additional investigations. This review will be useful for clinicians to develop an optimal approach to the assessment and therapy of mild and severe AUB in puberty.