J Clin Res Pediatr Endocrinol. 2023; 15(3): 230-237 | DOI: 10.4274/jcrpe.galenos.2023.2022-10-7

Evaluation of Abnormal Uterine Bleeding in Adolescents: Single Center Experience

Sirmen Kýzýlcan Çetin¹, Zehra Aycan², Elif Özsu¹, Zeynep Þýklar¹, Ayþegül Ceran¹, Seda Eriþen Karaca¹, Gizem Þenyazar¹, Merih Berberoðlu^1
1Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
²Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey and Ankara University Faculty of Medicine, Department of Adolescent Health, Ankara, Turkey

INTRODUCTION: Abnormal uterine bleeding (AUB) is the most common gynecologic complaint in adolescent girls. The aim of this study was to identify the diagnostic and management differences between those with/without heavy menstrual bleeding.
METHODS: Retrospective data was collected from adolescents aged 10-19 years, diagnosed with AUB. Adolescents with known bleeding disorders at admission were excluded. All girls were classified according to the degree of anemia; group 1 had heavy bleeding [hemoglobin (Hb) <10 g/dL] and group 2 had moderate or mild bleeding (Hb >10 g/dL). Admission and follow-up characteristics were compared between the two groups.
RESULTS: The cohort consisted of 79 girls with a mean age of 14.3±1.8 years and mean age of menarche of 11.9±1.4 years, with 85% experiencing menstrual irregularity in the two years after menarche, rising to 95.3% in group 1 (p<0.01). Anovulation was evident in 80% of the cohort. Of these 79 girls, 13 (16.5%) had polycystic ovary syndrome and two (2.5%) had structural anomalies (uterus didelphys). Three girls (group 1, n=2) had previously undiagnosed clotting factor VII deficiency; no other clotting deficiencies were diagnosed. Nineteen of 34 (56%) with personal (n=2)/family history of thrombosis had MTHFR mutation. None had venous thromboembolism during follow-up of >6 months.
DISCUSSION AND CONCLUSION: The majority of AUB (85%) occurred in the first two years after menarche. A small proportion (3.8%) had undiagnosed clotting factor deficiency. The frequency of MTHFR mutation was 50% in girls with history of thrombosis; however this did not increase the risk of bleeding/thrombosis and so routine evaluation does not appear to be justified.

Keywords: Abnormal uterine bleeding, adolescents, anovulatory bleeding, heavy menstrual bleeding

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