Overview of abnormal uterine bleeding in adolescents: Diagnosis and management

Abstract

Abnormal uterine bleeding (AUB) is a frequent cause of visits to health care provider during adolescent period and is characterized by irregular, excessively heavy, prolonged and/or frequent bleeding of uterine origin. Although many etiologies cause AUB, the one most likely cause among adolescents are dysfunctional uterine bleeding (DUB). DUB describes any kind of abnormal bleeding pattern that is not attributable to any structural or systemic disease. Anovulation due to immaturity of the hypothalamic-pituitary-ovarian (HPO) axis is the leading cause in the first 2-3 postmenarchal years. The primary goal of treatment is prevention of hemodynamic instability. Therefore, assessing the severity and cause of bleeding is important. Therapeutic approach in the acute period should be established according to the degree of anemia and amount of flow. Treatment options for medical care of DUB generally include: oral contraceptives, progestins, non-steroidal anti inflammatory drugs, anti-fibrinolytic agents, GnRH analogues and levonorgestrel releasing intrauterine system (LNG-IUS). Additionally, long-term management with hormonal therapy in patients with severe uterine bleeding is known to be safe for developing HPO axis.