Abnormal uterine bleeding in adolescents: Management
- Nirupama K De Silva, MD
Nirupama K De Silva, MD
- Clinical Associate Professor
- University of Oklahoma-Tulsa
- Section Editors
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- Mitchell Geffner, MD
Mitchell Geffner, MD
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Keck School of Medicine, University of Southern California
Menstrual disorders and abnormal uterine bleeding (AUB) are among the most frequent gynecologic complaints of adolescents . AUB refers to bleeding that is excessive or occurs outside of normal cyclic menstruation . AUB is described by a variety of terms and may be caused by a number of genital and nongenital tract diseases, systemic disorders, and medications (table 1). (See "Differential diagnosis of genital tract bleeding in women".)
The treatment for these disorders ranges from observation to pharmacologic and/or surgical therapy. Potential sequelae of AUB include anemia  and, less commonly in adolescents, endometrial cancer . With appropriate management of the underlying problem, these sequelae may be prevented. Thus, it is crucial to establish the correct diagnosis before any therapy is administered. (See "Abnormal uterine bleeding in adolescents: Definition and evaluation" and "Abnormal uterine bleeding in adolescents: Differential diagnosis and approach".)
The management of AUB in adolescents will be discussed here. The evaluation of AUB in adolescents is discussed separately, as are the evaluation and management of AUB in premenopausal women. (See "Abnormal uterine bleeding in adolescents: Definition and evaluation" and "Abnormal uterine bleeding in adolescents: Differential diagnosis and approach".)
The discussion below primarily pertains to AUB in otherwise healthy adolescents. The management of AUB in adolescents who have chronic disease, underlying coagulation disorders, or are undergoing chemotherapy, solid organ, or hematopoietic stem cell transplantation is beyond the scope of this discussion. Such patients should be managed in conjunction with the appropriate subspecialist. (See "Heavy or irregular uterine bleeding during chemotherapy".)
Abnormal uterine bleeding (AUB) in adolescents may be caused by a number of underlying problems (table 1). Anovulatory bleeding is the primary cause for abnormal uterine bleeding in the adolescent population .
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- General principles
- Rationale for hormonal therapy
- Choice of agent(s)
- ACUTE MANAGEMENT
- Mild anovulatory uterine bleeding
- Moderate anovulatory uterine bleeding
- - Moderate anovulatory uterine bleeding, not currently bleeding
- - Moderate anovulatory uterine bleeding, currently bleeding
- - Duration of therapy and follow-up
- Severe anovulatory bleeding
- - Hospitalization
- - Hormonal therapy
- Combination OC pills
- Progestin-only pills
- Conjugated estrogen
- - Hemostatic therapy
- - Surgical therapy
- - Discharge criteria
- LONG-TERM MANAGEMENT
- Maintenance therapy
- - Combination OC
- - Progestin-only
- SUMMARY AND RECOMMENDATIONS