Evaluation and Management of Abnormal Uterine Bleeding in Adolescents
Initial Assessment and Diagnosis
- The American Academy of Family Physicians recommends obtaining a detailed menstrual history including regularity, duration, frequency, and volume of bleeding to assess for abnormal uterine bleeding in adolescents 1
- Evaluation for signs of hyperandrogenism (acne, hirsutism) that may suggest polycystic ovary syndrome is recommended in the initial assessment of abnormal uterine bleeding in adolescents 1
Laboratory Testing and Imaging
- Pregnancy testing (β-hCG) is recommended to rule out pregnancy-related bleeding in adolescents with abnormal uterine bleeding 1, 2
- Thyroid-stimulating hormone (TSH) and prolactin level measurements are recommended to rule out thyroid dysfunction and hyperprolactinemia in adolescents with abnormal uterine bleeding 1, 2
- Transabdominal ultrasound is the preferred initial imaging modality for virgins with abnormal uterine bleeding, while transvaginal ultrasound may be appropriate in sexually active adolescents 3, 4, 5
- Ultrasound helps identify structural causes (polyps, adenomyosis, leiomyoma) of abnormal uterine bleeding in adolescents 3, 2
Management Approach
- The American Academy of Family Physicians recommends combined hormonal contraceptives as first-line treatment for mild to moderate bleeding with anovulation in adolescents 1
- Progestin-only options (oral, injectable, or intrauterine) are recommended as alternatives for the treatment of mild to moderate bleeding with anovulation in adolescents 1
- Surgical options, such as hysteroscopic removal of polyps, are rarely needed in adolescents but may be considered for the treatment of bleeding with structural abnormalities 1