Abnormal Uterine Bleeding in Adolescents

Elisabeth H. Quint, MD, Yolanda R. Smith, MD

J Midwifery Womens Health. 2003;48(3)

Prognosis

The majority of adolescents with AUB will spontaneously convert to normal menstrual cycles within 1 to 2 years, and this information and reassurance should be relayed to her. Education and support for the adolescent and her family are very important, because sustained heavy bleeding is a confusing and frightening event.

The prognosis is more guarded in the presence of acute anemia and in those women with continued irregular bleeding after several years. A 25-year prospective evaluation of adolescents with dysfunctional uterine bleeding showed that of those who continued to have abnormal bleeding after 2 years, persistent problems were noted in 50% after 4 years and in 30% after 10 years.^[28]

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Table 1. Differential Diagnosis of Abnormal Uterine Bleeding in Adolescents
Immaturity of the HPO axis
Coagulation disorders
Idiopathic thrombocytopenic purpura (ITP)
Von Willebrand's disease
Platelet function defect
Pregnancy complications
Abortion (complete, incomplete, missed)
Ectopic pregnancy
Trophoblastic disease
Genital tract infection
Vaginitis
Cervicitis
Vaginal foreign body
Salpingo-oophoritis
Endometritis
Endocrinopathies
Polycystic ovary disease
Hyperprolactinemia
Thyroid abnormalities
Premature ovarian failure
Hypothalamic dysfunction
Anorexia, stress, excessive exercise
Benign lesions of the genital tract
Cervical polyp
Vaginal adenosis
Endometriosis
Leiomyoma
Iatrogenic: drugs or hormones
Trauma
Malignant lesions of the genital tract
Vaginal carcinoma
Cervical carcinoma
Ovarian tumors

Table 2. Management of Dysfunctional Uterine Bleeding
Hemoglobin >10 g/dL
Reassurance and education
Iron supplementation
Menstrual calendar
Consider oral contraceptives if desired by patient
Prostaglandin inhibitors
Periodic reevaluation
Hemoglobin <10 g/dL
No active bleeding
Consider referral or consult with a physician
Iron supplementation
Therapy: oral contraceptives
Cyclic progestin therapy; prostaglandin inhibitors
Reevaluation in 3 to 6 months
Active bleeding but stable
Consider referral or consult with a physician
Cascade oral contraceptive regimen: 30 to 35-mcg ethinyl estradiol
1 pill qid for 4 days
1 pill tid for 4 days
1 pill bid for 4 days
1 pill qd until two pill packs are finished
Iron supplementation
Reevaluate by phone in a few days; if bleeding not slowed down, physician consult
Continue treatment for 1 year; then reevaluate
Acute hemorrhage
Immediate consult with physician for possible transfusion and admission

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Abnormal Uterine Bleeding in Adolescents

Prognosis

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Tables

References

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