Abnormal uterine bleeding in adolescence

Authors

  • Sunita Samal Department of Obstetrics and Gynecology, SRM MCH and RC, Kattankullathur, Chennai, Tamil Nadu, India
  • Ashwini Vishalakshi Department of Obstetrics and Gynecology, MGMC and RI, Puducherry, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20181320

Keywords:

Adolescence, AUB

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).

References

Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediat. 2006;118(5):2245-50.

Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):383-90.

Menstrual disturbances in puberty. Best Pract Res Clin Obstet Gynecol. 24;2010:157-71.

Meijer WE, Heerdink ER, Nolen WA. Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants. Arch Intern Med. 2004;164(21):2367-70.

James AH. Bleeding disorders in adolescents. Obstet Gynecol Clin North Am. 2009;36(1):153-62.

Philipp CS, Faiz A, Dowling NF. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol. 2008;198(2):163.e1-8.

Pollack A. ACOG Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 46, September 2003.(Replaces technical bulletin number 222, April 1996). Obstet Gynecol. 2003 Sep;102(3):647-58.

Blombäck M, Konkle BA, Manco-Johnson MJ, Bremme K, Hellgren M, Kaaja R. ISTH SSC Subcommittee on Women’s Health Issues. Preanalytical conditions that affect coagulation testing, including hormonal status and therapy. J Thromb Haemost. 2007;5(4):855-8.

VG Padubidri, SN Daftary. Shaw’s textbook of gynecology. 15th Ed. Elsevier health sciences; 2010.

Schorge JO, Schaffer JI, Halvorson LM. Williams Gynecology. McGraw-Hill;2008.

Rimsza ME. Dysfunctional uterine bleeding. Pediatr Rev. 2002;23(7):227-33.

Chi C, Huq FY, Kadir RA. Levonorgestrel-releasing intrauterine system for the management of heavy menstrual bleeding in women with inherited bleeding disorders: long-term follow-up. Contracep. 2011;83(3):242-7.

Aslam N, Blunt S, Latthe P. Effectiveness and tolerability of levonorgestrel intrauterine system in adolescents. J Obstet Gynaecol. 2010;30(5):489-91.

Emans SJ. Dysfunctional uterine bleeding. In: Emans SJ, Laufer MR, Goldstein DP, eds. Pediatric and Adolescent Gynecology. 5th Ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2005:270.

Mannucci PM. Treatment of von Willebrand’s disease. N Engl J Med. 2004;351(7):683-94.

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Published

2018-03-27

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Section

Review Articles