Endocrine Abstracts

Introduction: Abnormal uterine bleeding (AUB) refers to uterine bleeding that is excessive or occurs outside of normal cyclic menstruation. The most common cause of AUB in adolescents is anovulatory cycles due to immature hypothalamic-pituitary-ovarian axis. Additionally, endocrinological problems (hypothyroidism, hyperprolacitenemia, etc.) and bleeding disorders may cause AUB. The management of AUB begins with an assessment of whether or not the patient is hemodynamically stable and then proceeding with medical management based on etiology and the severity of anemia. The aim of the study was to assess etiological factors and treatment of AUB in adolescents in our clinic.

Method: We evaluated the clinical and laboratory features of 29 adolescents with AUB referred to adolescent outpatient clinic within 2 years of time. Hemogram, TSH, free T4, beta HCG, FSH, LH, E2, prolactin and von Willebrand factor antigen, prothrombin time, partial thromboplastin time measurement and pelvic ultrasonography were done in all patients. The severity of bleeding was assessed as mild(Hb: ≧12 g/dl), moderate(Hb: 10–12 g/dl) and severe(Hb: <10 g/dl).

Results: The mean age of the patients at menarche and admission were 12.1±0.9 (10.5–14.0) and 13.7±1.6 (11.3–16.9) years respectively (mean time between them 1.6±1.3 (0.0–4.9) years). 55% of the patients had heavy and irregular menstrual bleeding and 45% of the patients had heavy bleeding since menarche. The severity of bleeding was assessed as mild in five patients, moderate in four patients and severe in 20 patients. None of them were found to have a bleeding disorder and one patient had uterus didelphys. One patient with severe AUB had hypothyroidism. In 93% of the patients AUB was due to anovulatory cycles. 25 (86%) patients were treated with oral contraceptives. Three patients were treated with tranexamic acid and six patients had to be given erythrocyte transfusion due to hemodynamic instability.

Conclusion: The most common cause of AUB in adolescents is anovulatory cycles. Once hemodynamic stability is controlled and provided, the patient must be evaluated for severity of anemia, possible bleeding disorders and causes of AUB.