Treatment Options for the Adolescent Patient Experiencing Abnormal Uterine Bleeding

Abstract

Opinion statementAbnormal uterine bleeding (AUB) is one of the most common reasons adolescent patients present for gynecologic care. A new classification system has been created to provide a universally accepted system of nomenclature to describe uterine bleeding causes in reproductive-aged women. The acronym PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not yet classified) was introduced in 2011. This classification will help to target not only treatment but also future research into treatment options in the AUB population. In order for treatments to be effective, an accurate diagnosis is paramount. Adolescents tend to have anovulatory, infectious, or pregnancy-related causes of AUB. Traditional treatment modalities have been hormonal in nature, the most common being the use of oral contraceptive pills. The latest development has been the recognition of the effective use of the levonorgestrel intrauterine systems (LNG-IUS) in successful treatment of AUB in the adolescent population.

Abnormal Uterine Bleeding in Adolescents: A Multidisciplinary Approach

“…As abnormal uterine bleeding (AUB) is a common scenario that gynaecologists, paediatricians and primary care providers face in the care of adolescent patients. 1,2 It is the single most common complaint that makes reproductive age women seek medical help. 2,3 This problem has a huge impact on quality of life, promoting school absenteeism and limitations in social life.…”

“…1,2 It is the single most common complaint that makes reproductive age women seek medical help. 2,3 This problem has a huge impact on quality of life, promoting school absenteeism and limitations in social life. [4][5][6] AUB may be either acute or chronic, and therefore patients may present in either an emergency or outpatient setting.…”

“…11 These girls should have a consultation with a gynaecologist or haematologist prior to menarche. 1,2,8 At every consultation after menarche, the last menstrual period, menstrual patterns and amount of blood loss should be assessed as if they were a clinical vital signs. 2 A smartphone application may facilitate recording and may be preferred over paper by adolescents.…”

“…1,2,8 At every consultation after menarche, the last menstrual period, menstrual patterns and amount of blood loss should be assessed as if they were a clinical vital signs. 2 A smartphone application may facilitate recording and may be preferred over paper by adolescents. 12 It has been demonstrated that a multidisciplinary protocol for work-up in adolescents with heavy menstrual bleeding Correction/ Errata: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/16382 (HMB) can reduce time to diagnosis and improve outcomes.…”

The use of levonorgestrel-releasing intrauterine devices in adolescents — own experience

“…LNG-IUD is an excellent management option for a patient experiencing chronic abnormal uterine bleeding. It is more effective than oral medication as a treatment for heavy menstrual bleeding and it is associated with a greater reduction in heavy menstrual bleeding and improvement in quality of life, and appears to be more acceptable long term [7].…”