Excessive uterine bleeding.

Area of Science:

• Adolescent Gynecology
• Reproductive Endocrinology

Background:

• Abnormal menstrual bleeding in adolescents causes significant concern.
• Anticipatory guidance on menarche and bleeding patterns can reduce anxiety.
• Eliciting a menstrual history can be challenging; tools like menstrual calendars and the pictorial bleeding assessment calendar (PBAC) aid assessment.

Purpose of the Study:

• To review the evaluation and management of abnormal menstrual bleeding in adolescent girls.
• To highlight the importance of confidential history taking and considering differential diagnoses beyond HPO axis immaturity.
• To emphasize timely laboratory testing before interventions.

Main Methods:

• Review of existing literature and clinical guidelines.
• Discussion of diagnostic challenges and tools for menstrual history.
• Outline of key differential diagnoses including PCOS and vWD.
• Consideration of management strategies and timing of laboratory tests.

Main Results:

• Not all abnormal bleeding is due to HPO axis immaturity; conditions like PCOS and vWD must be ruled out.
• Confidential history taking is crucial for addressing pregnancy and infectious causes.
• Laboratory testing for PCOS and vWD is influenced by concurrent therapies.

Conclusions:

• Comprehensive evaluation is necessary for abnormal uterine bleeding in adolescents.
• Early identification and management of underlying conditions like PCOS and vWD are critical.
• Hormonal stabilization and antifibrinolytics are key management strategies.