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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Causes of abnormal uterine bleeding in nonpregnant adolescents according to bleeding pattern

Causes of abnormal uterine bleeding in nonpregnant adolescents according to bleeding pattern
Bleeding pattern Associated clinical features Suggested evaluation
Amenorrhea
Primary amenorrhea
  • Absence of menarche by age 15 years
  • Refer to UpToDate content on primary amenorrhea
Secondary amenorrhea
  • Absence of menses for:
    • ≥90 days in adolescents who had regular menstrual cycles, or
    • ≥6 months in adolescents who had irregular menstrual cycles
  • Refer to UpToDate content on secondary amenorrhea
Irregular bleeding (unpredictable in timing and volume)
Common causes
Anovulatory uterine bleeding due to immature HPO axis
  • First year or two after menarche
  • Absence of premenstrual symptoms (eg, breast tenderness, weight gain, mood swings, cramping)
  • Absence of clinical features associated with other causes
  • Evaluation to exclude other possible causes of anovulatory uterine bleeding as indicated clinically
PCOS
  • Hyperandrogenism (hirsutism, acne, clitoromegaly)
  • Obesity
  • Refer to UpToDate content on diagnosis of PCOS in adolescents
Less common causes
Hypothyroidism or hyperthyroidism
  • Recent weight gain or loss
  • Heat or cold intolerance
  • Family history of thyroid dysfunction
  • Thyroid-stimulating hormone
Hyperprolactinemia
  • Galactorrhea, headache, visual changes
  • Prolactin
Hypothalamic dysfunction
  • Poor nutrition
  • Intense exercise
  • Psychosocial stress
  • Follicle-stimulating hormone
  • Luteinizing hormone
Intermittent nonuterine bleeding mimicking irregular menses
  • Clinical features of sexually transmitted infection (eg, vaginal discharge, vulvovaginal lesions, post-coital bleeding)
  • Examination of external genitalia
  • Testing for sexually transmitted infection as indicated
Regular menses with excessive flow
Common causes
Bleeding disorder
  • Heavy bleeding with first period
  • Symptoms of bleeding disorder (eg, bruising, epistaxis, gum bleeding)
  • Family history of bleeding disorder
  • Complete blood count with platelets
  • Evaluation of peripheral blood smear
  • aPTT and PT
  • von Willebrand panel
Less common causes
Medications that affect hemostasis
  • Anticoagulant therapy
 
Hypothyroidism or hyperthyroidism
  • Recent weight gain or loss
  • Heat or cold intolerance
  • Family history of thyroid dysfunction
  • Thyroid-stimulating hormone
Structural lesions (eg, endometrial polyp, uterine leiomyoma [fibroid], congenital uterine anomaly)
  • Often asymptomatic
  • May be associated with pelvic pressure and pain
  • Pelvic ultrasonography
Regular menses with intermenstrual bleeding
Common causes
Hormonal contraception or intrauterine device
  • Recent initiation or poor adherence
 
Sexually transmitted infection
  • High-risk behaviors (eg, unprotected sexual activity, multiple partners)
  • Vaginal discharge
  • Vulvar lesions
  • Post-coital bleeding
  • Testing for sexually transmitted infection as indicated
Extrauterine causes of intermittent bleeding that may mimic intermenstrual uterine bleeding
Ectropion (eversion of the endocervix)  
  • Speculum examination
Perineal trauma
  • History of perineal trauma or forced sexual activity
  • Examination of external genitalia
Cervical polyps
  • Chronic inflammation of the cervical canal
  • Speculum examination
Medications
  • Anticoagulant therapy
 
HPO: hypothalamic-pituitary-ovarian; PCOS: polycystic ovary syndrome; aPTT: activated partial thromboplastin time; PT: prothrombin time.
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