Abnormal Uterine Bleeding in the Adolescent

Abstract

Abnormal uterine bleeding is a common problem in adolescents. The differential diagnosis varies from pregnancy and infection to anovulation and coagulopathy. Careful history and examination can help elucidate the best next steps for workup and management. Heavy menstrual bleeding is particularly worrisome in this group not only when it occurs at menarche, but also anytime afterward when bleeding lasts longer than 7 days, blood loss is greater than 80 mL per cycle, or other warning signs that indicate a history of heavy bleeding such as anemia. Once conditions of pregnancy, infection, structural abnormalities, and hormonal causes have been ruled out, first-line treatment is medical management with hormonal therapy or nonhormonal options. Invasive measures are a last resort in this patient population, because maintenance of fertility is of critical importance.

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“…Medical therapy is, no question, the first line in the adolescent population, because maintaining fertility is paramount. 6 More than 90% of the severe bleeding that occurs in adolescents is controlled with medical treatment. However, surgery is required in the event of life-threatening bleeding, when medical treatment is unsuccessful and in situations where a histopathology evaluation is needed.…”

Abnormal Uterine Bleeding in Adolescent

“…Irregular cycles occur most frequently within the first 2-3 years after menarche. 6 The time required for HPO axis maturation following menarche, which is thought to result in ovulatory cycles and subsequent regular bleeding, varies between six months and three years. Due to ovulatory dysfunction, in the following months after menarche, irregular and unpredictable, heavy and prolonged, and, rarely, skipped menses for less than three months may occur.…”

“…Ovulatory dysfunction due to an immature hypothalamic-pituitary-ovarian axis occurs in up to 95% of adolescents with AUB. 6 Abnomal Uterine Bleeding might also be classified as acute or chronic. Acute AUB refers to an episode of heavy bleeding which is sufficient in quantity to require immediate intervention to prevent further blood loss.…”

“…Other population-based studies have reported that 12.1% and 17.9% of adolescents experienced heavy menstrual bleeding in Nigeria and Hong Kong, respectively. 6,9…”

“…Up to 20% of adolescents with heavy menstrual bleeding have subsequently been found to have a bleeding disorder. 6 Excessive bleeding during menarche can usually indicate an underlying bleeding disorder, while regular but excessive bleeding may also be indicative of bleeding disorders. 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.…”