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 in 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 "Abnormal uterine bleeding in adolescents: Differential diagnosis and approach".)
Anovulatory uterine bleeding is the primary cause of AUB in adolescents and generally resolves with maturation of the hypothalamic-pituitary-ovarian axis.
The management of abnormal uterine bleeding in otherwise healthy adolescents is the focus of this topic review. 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 topic review. Such patients should be managed in conjunction with the appropriate subspecialist. As an example, (see "Heavy or irregular uterine bleeding during chemotherapy").
The evaluation of AUB in adolescents and the evaluation and management of causes of AUB other than anovulatory uterine bleeding in premenopausal women are discussed separately:
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- TERMINOLOGY AND ETIOLOGY
- SEVERITY CLASSIFICATION
- GOALS OF MANAGEMENT
- GENERAL PRINCIPLES
- Pretreatment evaluation
- Management of iron deficiency
- Hormone effects
- Monitoring response
- ACUTE MANAGEMENT OF MILD ANOVULATORY UTERINE BLEEDING
- ACUTE MANAGEMENT OF MODERATE ANOVULATORY UTERINE BLEEDING
- Not currently bleeding
- Currently bleeding
- Treatment regimens
- - Combination estrogen-progestin
- - Progestin-only
- ACUTE MANAGEMENT OF SEVERE ANOVULATORY UTERINE BLEEDING
- Indications for hospitalization
- - Additional evaluation
- Hormonal therapy
- - Combination therapy
- - Progestin-only pills
- - Intravenous estrogen
- Addition of hemostatic therapy
- Refractory uterine bleeding
- LONG-TERM MANAGEMENT
- Maintenance therapy
- - Initial control with estrogen-containing regimen
- - Initial control with oral progestin
- Follow-up schedule
- Long-term monitoring
- SUMMARY AND RECOMMENDATIONS