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Abnormal uterine bleeding in adolescents: Evaluation and approach to diagnosis

Nirupama K De Silva, MD
Section Editors
Amy B Middleman, MD, MPH, MS Ed
Mitchell E Geffner, MD
Deputy Editor
Mary M Torchia, MD


Abnormal uterine bleeding (AUB) refers to uterine bleeding that is excessive or occurs outside of normal cyclic menstruation [1].

The evaluation of common causes of AUB in adolescents will be discussed here. The management of AUB in adolescents and a more comprehensive discussion of the evaluation of AUB in older reproductive-age women are presented separately. (See "Abnormal uterine bleeding in adolescents: Management" and "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women".)


The normal menstrual cycle results from a complex feedback system involving the hypothalamus, pituitary, ovary, and uterus (figure 1).

Timing and flow – Although menstrual cycles vary considerably during the first five to seven years after menarche, the majority of cycles last 21 to 45 days with two to seven days of menstrual bleeding [2-6]. By the third postmenarchal year, 95 percent of cycles fall into this range (figure 2) [7]. The average adult menstrual cycle lasts 28 days to 35 days with four to six days of menstrual bleeding. The median blood loss during each menstrual period is 30 mL; the upper limit of normal is 80 mL. (See "Physiology of the normal menstrual cycle".)

Establishing ovulatory cycles – In the first postmenarchal year, approximately 50 percent of cycles are anovulatory. The duration of time that it takes to establish regular ovulatory cycles increases with increasing age at the time of menarche [8,9]. One-half of cycles are ovulatory by one year in girls with menarche at <12 years, by three years in girls with menarche between 12 and 13 years, and by 4.5 years in girls with menarche at ≥13 years [8]. (See 'Anovulatory uterine bleeding' below.)

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Literature review current through: Nov 2017. | This topic last updated: Jun 12, 2017.
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