Etiology of abnormal uterine bleeding in adolescents – emphasis upon polycystic ovarian syndrome

Abstract

Introduction: Abnormal uterine bleeding is a frequent reason for physician visits by adolescents and this menstrual disorder has been shown to adversely affect quality of life. In Indian context, adolescents constitute 21.4% of the total population and this age group needs special attention as these are the formative years of an individual when major changes take place. Objectives: To evaluate polycystic ovarian syndrome as common cause for abnormal uterine bleeding in adolescents. Methods: We studied 200 patients aged 10 to 20 years admitted in our department with abnormal uterine bleeding having severe anemia or hemodynamic instability. On admission detailed history and clinical examination was taken. Hormonal testing for PCOS and other necessary investigations were done. Results: Of the 200 patients, the mean age was 15.2+2.4 years. Mean hemoglobin was 6.0+1.5 g. 40% patients were over-weight/obese. PCOS accounted for 30% of admissions. Hypothalamic pituitary ovarian axis immaturity 30% of admissions, en-dometritis (12%), bleeding disorders (14%). PCOS was more likely in overweight/obese females. Girls with HPOaxis immaturity had hemoglobin less than other etiologies. Conclusion: PCOS is the common underlying etiology in adolescents hospitalized with abnormal uterine bleeding. Screening is important for early diagnosis to allow ongoing management and prevention of comorbidity.