Comparison of treatment outcomes among adolescents with acute uterine bleeding

To measure the association between treatment options and clinical outcomes in adolescent patients with acute uterine bleeding.

A cohort study was conducted using data collected on chart review of all patients under 19 years-old treated for acute uterine bleeding from 2012 until 2022 in our tertiary-care hospital center. The association between the treatment options (high-dose estrogens versus progestins) and two primary outcomes (delta of hemoglobin level from baseline to discharge and time to bleeding cessation) were measured using linear regressions with adjustment for potential confounding variables. As secondary outcomes, delta of hemoglobin from baseline to 1 and 4 months, side effects and adverse events were analyzed.

We included 150 patients in our study, 116 exposed to high-dose estrogens and 34 to high-dose progestins. The median time to bleeding cessation was 36 hours overall (Q25,75: 17.5, 85.5) without statistically significant difference between treatment groups. The delta of hemoglobin at discharge and at 4 months, after adjustment, showed a tendency towards a better increase in hemoglobin levels for the progestin group, without statistical significance. The progestin group experienced less side effects compared to estrogen group (adjusted OR = 0.31 (95%CI: 0.10, 0.89 for a composite nausea outcome). Treatment failure occurred in 23.1% of cases, without significant difference across groups and no thromboembolic event were reported.

This study suggests no statistically significant difference in the effectiveness between the two treatment protocols, but a better side effect profile for high-dose progestins.