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Kızılcan Çetin S, Aycan Z, Özsu E, Şıklar Z, Ceran A, Erişen Karaca S, Şenyazar G, Berberoğlu M. Evaluation of Abnormal Uterine Bleeding in Adolescents: Single Center Experience. J Clin Res Pediatr Endocrinol 2023; 15:230-237. [PMID: 36794870 PMCID: PMC10448548 DOI: 10.4274/jcrpe.galenos.2023.2022-10-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
Objective 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. 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.
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Affiliation(s)
- Sirmen Kızılcan Çetin
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zehra Aycan
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
- Ankara University Faculty of Medicine, Department of Adolescent Health, Ankara, Turkey
| | - Elif Özsu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayşegül Ceran
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Seda Erişen Karaca
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Gizem Şenyazar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Screening hemostatic defects in Saudi University students with unexplained menorrhagia: a diagnosis, which could be missed. Blood Coagul Fibrinolysis 2021; 32:278-284. [PMID: 33741756 DOI: 10.1097/mbc.0000000000001033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bleeding disorders are a common cause of unexplained menorrhagia in adolescents. However, there is lack of information provided on Arab girls. To estimate the prevalence of coagulation factor deficiencies and platelet dysfunction among Saudi university students with unexplained menorrhagia. In this cross sectional study, 463 adolescent girls surveyed for having heavy menses for further evaluation of underlying bleeding tendencies using screening standardized questionnaire. Only 109 girls out of the total 463 girls reported menorrhagia and were included in the evaluation. All girls with menorrhagia were evaluated by Pictorial blood assessment chart (PBAC) for precise evaluation of menstrual blood loss (PBAC score >100), had underwent pelvic ultrasonography and screening of hemostatic abnormalities (complete blood count, PFA-100, PT, aPTT, vWF:RCo, vWF:Ag, coagulation factors assay). On the basis of the score of PBAC more than 100, 25.6% (28/109) of adolescent women (age ranged: 17-25 years old) had confirmed menorrhagia. In 30.8% of them, an ultimate diagnosis of bleeding tendency or hemostatic abnormality was detected [five cases of probable von Willebrand disease (vWD) or low level of vWF:Ag and/or vWF:RCo, two cases of probable platelet dysfunction, and one case of factorV (FV) deficiency]. Anemia was found in 39.28% (11/28) of them; however, only 4 (36%) had received iron supplements. Our study demonstrated that hemostatic defects are not uncommon in Saudi adolescent women presenting with menorrhagia but mostly unrecognized and untreated. It is probably advisable to screen women with menorrhagia for these defects.
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Hossenbaccus L, Thibeault L, Grabell J, Braund H, Hopman W, James P. Evaluating the effectiveness of let's talk period's high school educational outreach program: A pilot study. Haemophilia 2021; 27:470-478. [PMID: 33626190 DOI: 10.1111/hae.14277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Menorrhagia impacts ~40% of adolescent females, with about half having an underlying bleeding disorder, most commonly von Willebrand Disease (VWD). VWD affects ~1 in 1000 individuals, though many are unaware of their condition. Let's Talk Period (LTP) is an online knowledge translation platform aimed at increasing awareness of bleeding disorders symptoms, with a validated self-administered bleeding assessment tool (Self-BAT). AIM To evaluate the effectiveness of the LTP high school outreach program in Grade 9 girls' health classes quantitatively, using baseline, post-presentation, and follow-up quiz scores, and qualitatively, with student and teacher feedback forms. METHODS The 75-minute in-class presentations, developed in alignment with the 2015 Ontario Curriculum for Grade 9 Health and Physical Activity, were led by a haemophilia nurse, clinical research assistant, and undergraduate student from the LTP team. Students completed baseline, post-presentation, and 4-6-week follow-up Kahoot quizzes featuring the same nine questions to evaluate change in knowledge levels and retention. Both student and teacher feedback were collected. RESULTS There was a significant increase (p < 0.001) from baseline to post-presentation scores, with a significant gain in knowledge, for all questions (p < 0.01). Students found content related to the basics and management of menstruation to be most interesting. Many had constructive feedback on how the presentation method could be improved. On average, the presentations were rated an 8.6 of 10 by students and 8.75 of 10 by teachers. CONCLUSION The LTP high school outreach program effectively increases student knowledge of menorrhagia and bleeding disorders. It was well-received by students and staff alike.
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Affiliation(s)
- Lubnaa Hossenbaccus
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Lisa Thibeault
- Clinical Research Centre, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Julie Grabell
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Faculty of Education and the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Wilma Hopman
- Clinical Research Centre, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Paula James
- Department of Medicine, Queen's University, Kingston, ON, Canada
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Adolescents Presenting to the Emergency Department with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2020; 33:139-143. [PMID: 31765796 DOI: 10.1016/j.jpag.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To describe the adolescent population that seeks care in the emergency department (ED) for heavy menstrual bleeding (HMB), and to compare those who are discharged to those who are admitted to the hospital. DESIGN Retrospective study. SETTING Emergency department and inpatient unit at a national tertiary care hospital from 2006-2018. PARTICIPANTS Adolescents 11-19 years old with ICD-9 and ICD-10 codes for HMB. INTERVENTIONS Chart abstraction for demographic data, symptoms, laboratory tests, outcomes, and treatments. MAIN OUTCOME MEASURE Adolescents who were admitted were compared to girls who were treated as outpatients. RESULTS There were 258 adolescents who sought care for HMB in the ED during the study period. A total of 44 patients (17%) were admitted to the hospital, whereas 214 (83%) were discharged. The average age of those admitted was 15 years, compared to 17 years for those discharged (P < .001). In the admitted group, the mean initial hemoglobin (Hgb) was 6.3 g/dL compared to 12.0 g/dL in the discharged group (P < .0001). Only 23% of the discharged patients were released with medications; the remainder did not receive treatment. Anovulation was the etiology of HMB in the majority (56%) of both inpatients and outpatients. Of the 44 adolescents admitted to the hospital for HMB, 12 (27%) had a bleeding disorder (BD) and 32 (73%) did not. CONCLUSION The majority of adolescents who presented to the emergency department for HMB were not anemic and did not receive any treatment. Of those admitted, almost one-third had an underlying BD, which is higher than previously reported.
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Papapanagiotou IK, Charamanta M, Roidi S, Al-Achmar NS, Soldatou A, Michala L. The Use of Norethisterone for the Treatment of Severe Uterine Bleeding in Adolescents: An Audit of Our Experience. J Pediatr Adolesc Gynecol 2019; 32:596-599. [PMID: 31520717 DOI: 10.1016/j.jpag.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE The purpose of this prospective study was to assess the effectiveness of norethisterone (NET) in the management of abnormal uterine bleeding (AUB) in adolescents in a tertiary care center. DESIGN This was a prospective audit focused on administering high doses of NET in female adolescents with complaints of AUB. SETTING We included female adolescents who presented to our Emergency Gynecological Department or Adolescent Gynecological Outpatient Department from October 2016 to January 2019. PARTICIPANTS The study included 29 female adolescents aged 11-17 (mean, 13.14) years. INTERVENTIONS Patients were administered a daily dose of 10-30 mg, depending on the severity of the condition, bleeding duration, and patient weight. MAIN OUTCOME MEASURES Cessation of vaginal bleeding. RESULTS Mean age at menarche of our patient sample was 11.4 years (range, 10.7-14 years). AUB presented at a mean time of 24.6 months after menarche (range, 0-79 months). Blood transfusion was deemed necessary in 9 patients. Bleeding stopped at a mean of 46.1 (range, 8-120) hours after onset of treatment with NET. No serious adverse events were reported with NET administration, with only 3 cases of minor side effects. CONCLUSION The use of NET is an effective and reliable treatment option among adolescents for whom control of AUB is desired in the acute setting.
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Affiliation(s)
- Ioannis K Papapanagiotou
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Maria Charamanta
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Stella Roidi
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Nikolaos Samer Al-Achmar
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Panagiotis and Aglaia Kyriakou Hospital, Athens, Greece
| | - Lina Michala
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece.
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Graham RA, Davis JA, Corrales-Medina FF. The Adolescent with Menorrhagia: Diagnostic Approach to a Suspected Bleeding Disorder. Pediatr Rev 2018; 39:588-600. [PMID: 30504251 DOI: 10.1542/pir.2017-0105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Rudi-Ann Graham
- Department of Pediatrics, Holtz Children's Hospital-Jackson Memorial Medical Center, Miami, FL.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine, Miami, FL
| | - Joanna A Davis
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine, Miami, FL.,University of Miami-Hemophilia Treatment Center, Miami, FL
| | - Fernando F Corrales-Medina
- Department of Pediatrics, Holtz Children's Hospital-Jackson Memorial Medical Center, Miami, FL.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine, Miami, FL.,University of Miami-Hemophilia Treatment Center, Miami, FL
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Cooke AG, McCavit TL, Buchanan GR, Powers JM. Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2017; 30:247-250. [PMID: 27789349 DOI: 10.1016/j.jpag.2016.10.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To assess the clinical severity and initial treatment of iron deficiency anemia (IDA) in female adolescents with heavy menstrual bleeding (HMB) in our center. DESIGN Retrospective cohort study of electronic medical records via search of administrative records using International Classification of Diseases Ninth Revision codes for IDA or unspecified anemia and disorders of menstruation. SETTING Children's Medical Center in Dallas, Texas. PARTICIPANTS One hundred seven patients with HMB and concomitant IDA (median age, 14.4 years) who presented to the outpatient, emergency department, and/or inpatient settings. RESULTS The median initial hemoglobin concentration for all patients (n = 107) was 7.4 g/dL, and most (74%, n = 79) presented to the emergency department or via inpatient transfer. Symptomatic IDA was treated with blood transfusion in 46 (43%, n = 46). Ferrous sulfate was the most commonly prescribed oral iron therapy. Seven patients received intravenous iron therapy either initially or after oral iron treatment failure. Combined oral contraceptives were commonly prescribed for abnormal uterine bleeding, yet 10% of patients (n = 11) received no hormonal therapy during their initial management. Evaluation for underlying bleeding disorders was inconsistent. CONCLUSION Severe anemia because of IDA and HMB resulting in urgent medical care, including hospitalization and blood transfusion, is a common but underemphasized problem in adolescent girls. In addition to prevention and early diagnosis, meaningful efforts to improve initial management of adolescents with severe HMB and IDA are necessary.
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Affiliation(s)
- Amanda G Cooke
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Timothy L McCavit
- Division of Hematology-Oncology, Department of Pediatrics, Cook Children's Hospital, Fort Worth, Texas
| | - George R Buchanan
- Division of Hematology-Oncology, Department of Pediatrics, UT Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Jacquelyn M Powers
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
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Karaman K, Ceylan N, Karaman E, Akbayram S, Akbayram HT, Kaba S, Garipardıç M, Öner AF. Evaluation of the Hemostatic Disorders in Adolescent Girls with Menorrhagia: Experiences from a Tertiary Referral Hospital. Indian J Hematol Blood Transfus 2016; 32:356-61. [PMID: 27429530 PMCID: PMC4930760 DOI: 10.1007/s12288-015-0583-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022] Open
Abstract
Bleeding disorders are a common cause of menorrhagia in the adolescent age group. We aimed to evaluate the incidence of hemostatic disorders, using clinical and laboratory findings of bleeding disorders in adolescent girls with menorrhagia. A retrospective chart review used to evaluate adolescent girls with menorrhagia who were referred to Yuzuncu Yil University Pediatric Hematology clinic between January 2010 and December 2014. Out of 52 patients referred for investigation, 50 patients were included in the study. The mean age and mean menarche age were 14.8 ± 1.42 (range: 12-17) and 12.47 ± 0.55, respectively. In 42 % (n = 21) of patients, anemia was detected. In 22 % (n = 11) of patients, a bleeding disorder was detected: five cases with von Willebrand disease, two cases with acute immune thrombocytopenic purpura, one case with Bernard-Soulier syndrome, one case with Glanzmann thrombasthenia, one case with aplastic anemia and one case with factor X deficiency. The remaining 39 out of the 50 patients were finally diagnosed with dysfunctional uterine bleeding. When compared the patients with bleeding disorders and without bleeding disorders, bleeding from other sites, including gingival bleeding or epistaxis, low platelet counts and prolonged activated partial thromboplastin time were found statistically more frequent in patients with bleeding disorders (p < 0.05). Menorrhagia in adolescents is frequently associated with underlying bleeding disorders. Adolescents with heavy menstrual bleeding and a history of nose or gingival bleeding should be evaluated for congenital bleeding disorders.
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Affiliation(s)
- Kamuran Karaman
- />Department of Pediatric Hematology, Yuzuncu Yil University, 65100 Van, Turkey
| | - Nesrin Ceylan
- />Department of Pediatrics, Yuzuncu Yil University, Van, Turkey
| | - Erbil Karaman
- />Department of Obstetric and Gynecology, Yuzuncu Yil University, Van, Turkey
| | - Sinan Akbayram
- />Department of Pediatric Hematology, Yuzuncu Yil University, 65100 Van, Turkey
| | | | - Sultan Kaba
- />Department of Pediatric Endocrinology, Yuzuncu Yıl University, Van, Turkey
| | - Mesut Garipardıç
- />Department of Pediatric Hematology, Yuzuncu Yil University, 65100 Van, Turkey
| | - Ahmet Fayik Öner
- />Department of Pediatric Hematology, Yuzuncu Yil University, 65100 Van, Turkey
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Stimpson SJ, Rebele EC, DeBaun MR. Common gynecological challenges in adolescents with sickle cell disease. Expert Rev Hematol 2015; 9:187-96. [DOI: 10.1586/17474086.2016.1126177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Srivaths LV, Dietrich JE, Yee DL, Sangi-Haghpeykar H, Mahoney D. Oral Tranexamic Acid versus Combined Oral Contraceptives for Adolescent Heavy Menstrual Bleeding: A Pilot Study. J Pediatr Adolesc Gynecol 2015; 28:254-7. [PMID: 26024940 DOI: 10.1016/j.jpag.2014.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 12/09/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To compare the efficacy of oral tranexamic acid (TA) with combined oral contraceptives (COC) in reducing menstrual blood loss (MBL) and improving quality of life in adolescent heavy menstrual bleeding (HMB). DESIGN, SETTING, AND PARTICIPANTS A prospective randomized crossover trial with 17 postmenarchal girls aged 21 years and younger with HMB who were seen at our institution. INTERVENTIONS Patients were randomized to group A (TA arm) or group B (COC arm), each for 3 cycles, with crossover to the second arm after 1-month washout. MAIN OUTCOME MEASURES The primary end points were difference in improvement in MBL and QOL, from baseline to end of each therapy. RESULTS Seventeen patients were enrolled (mean age 14.2 years, range 11.7 to 16.8 years). Nine patients completed both arms; 8 patients withdrew from the study due to adverse events or noncompliance. Compared with baseline, significant improvement (P < .05) was demonstrated by TA and COC in MBL (mean Pictorial Blood Assessment Chart score decrease: TA, 536.4; COC, 430.6) and quality of life (mean Pediatric Quality of Life Inventory(TM) version 4.0 Generic Scales score increase: TA, 15.6; COC, 16.75), but no significant difference was noted between TA and COC (P > .05). There was statistically significant reduction in the length of menstrual cycle for COC only (mean reduction 5.3 days; P = .04) and not for TA (P = .18). Ten patients (58%) experienced adverse events that were possibly drug related (TA: n = 3, 30%; COCP: n = 7, 64%). CONCLUSION In this pilot study, oral TA appeared as efficacious as COC in the management of adolescent HMB by reducing MBL and improving quality of life.
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Affiliation(s)
- Lakshmi V Srivaths
- Department of Pediatrics, Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
| | - Jennifer E Dietrich
- Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Donald L Yee
- Department of Pediatrics, Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | | | - Donald Mahoney
- Department of Pediatrics, Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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Management of hematometrocolpos due to dysfunctional uterine bleeding following progestin use: a case report. North Clin Istanb 2014; 1:45-48. [PMID: 28058301 PMCID: PMC5175023 DOI: 10.14744/nci.2014.32932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/23/2014] [Indexed: 12/02/2022] Open
Abstract
Hematometrocolpos is accumulation of blood in the vagina and uterine cavity due to intra-uterine hemorrhage. A 20-year-old female presented to our clinic with massive menorrhagia at menarche after progestin usage. Hematometrocolpos was detected by transabdominal ultrasonography. She was pale because of heavy bleeding for 5 days and hemoglobin level was measured as 5.1 g/dl. Initial treatment was blood transfusion and medical drug therapy. After resolution of the hematometrocolpos was shown by transabdominal ultrasound 2 days later, the patient, who was stable, was discharged without complication. Obstruction of the female genital outflow tract is rarely seen. Hematocolpos has been reported in elderly women following vaginal occlusion due to radiotherapy, vaginal fibroma and labial synechiae causing infection or inflammatory conditions. The case is presented here because of the successful management of hematometrocolpos due to massive dysfunctional uterine bleeding in a young virgin patient.
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What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents. Curr Opin Pediatr 2014; 26:413-9. [PMID: 25007322 DOI: 10.1097/mop.0000000000000121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. The readers will learn a practical approach to the evaluation and treatment of mild-to-severe uterine bleeding. RECENT FINDINGS In 2011, a new classification system was proposed to standardize the terminology used to describe AUB. This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. The term dysfunctional uterine bleeding has been replaced by AUB. The negative effect of AUB on adolescents' quality of life is now well established. The levonorgestrel-releasing intrauterine system is considered a first-line treatment for heavy menstrual bleeding and should be considered, especially in those adolescents who may also need contraception. SUMMARY AUB is a common adolescent complaint that can vary from mild to life-threatening if not recognized and treated promptly. This article reviews the appropriate assessment and management of AUB and proposes a practical algorithm that can be used in an office or hospital setting.
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Hertweck P, Yoost J. Common problems in pediatric and adolescent gynecology. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Amesse LS, Pfaff-Amesse T, Gunning WT, Duffy N, French JA. Clinical and laboratory characteristics of adolescents with platelet function disorders and heavy menstrual bleeding. Exp Hematol Oncol 2013; 2:3. [PMID: 23347697 PMCID: PMC3584827 DOI: 10.1186/2162-3619-2-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Platelet function disorders (PFDs) have emerged as an important etiology of heavy menstrual bleeding (HMB) in adolescents. However, neither clinical nor laboratory data have been methodically analyzed in this population subset. The objective of this study was to evaluate these parameters in order to distinguish characteristics of the disorder that in turn will lead to earlier diagnosis and therapy initiation. METHODS Retrospective review of medical records from postmenarcheal adolescents with documented PFDs referred to a hemophilia treatment center and university faculty practices for bleeding diatheses with their clinical and laboratory data evaluated. RESULTS Of 63 teens with documented PFDs, HMB was the most common clinical manifestation of PFD (43; 68.3%). Of these, 37 (86%) were diagnosed with PFD either at or after menarche with the diagnosis based on HMB symptoms alone. Only 6 (14%) were diagnosed with a PFD prior to menarche, based on associated bleeding, i.e., epistaxis, ecchymosis, and all developed HMB after menstruation onset. Interestingly, 20 girls were diagnosed with a PFD prior to menarche and of these, only 6 (30%) went on to develop HMB after pubertal transition, while the majority (14; 70%) did not. The average age-at-PFD diagnosis was 14.5yrs, significantly differing from the 10.9yrs average age-at-PFD diagnosis in their counterparts that, after menarche, did not develop HMB (P<.01) Blood type O occurred significantly more frequently (76%) than national norms (P <.037). Incidence of δ-Storage Pool deficiency (δ-SPD) was significantly higher (74%) than their non-HMB cohorts (45%) (P <.007). Coagulation and von Willebrand factor studies were all normal. Abnormal closure times and aggregation studies were observed in 42% and 60%, respectively, of tested girls. In 25.6% for whom standard platelet studies were normal, electron microscopy detected reduced platelet δ-granules numbers (δ-SPD). CONCLUSIONS Adolescents with PFDs and HMB appear to be clinically distinct from their non-HMB counterparts. This group of girls is characterized by HMB the major bleeding symptom, significantly high incidences of blood group O and the δ-SPD with a PFD diagnosed well after menarche. High false negative standard platelet function study results indicate additional diagnostic strategies, particularly for δ-SPD, should be considered.
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Affiliation(s)
- Lawrence S Amesse
- Division of Reproductive Endocrinology and Infertility, Department of OB-GYN, Section of Pediatric-Adolescent Gynecology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
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Abstract
PURPOSE OF REVIEW Heavy menstrual bleeding (HMB) is an extremely common problem among adolescents. This article reviews the differential diagnosis and clinical presentation. Additionally, we aim to present the most up-to-date guidelines for evaluation and treatment. RECENT FINDINGS Bleeding disorders are now recognized as a common cause for menorrhagia. The recommended laboratory evaluation has evolved in the last few years. Most forms of hormonal contraception, including the levonorgestrel intra-uterine device, are effective and have been studied in adolescents. SUMMARY HMB is prevalent in the adolescent population and is associated with serious complications. Laboratory analysis to rule out bleeding disorders should be considered. Medical management, the cornerstone of treatment, has been proven to be safe and effective in this population.
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What's clinically relevant and new in pediatric and adolescent gynecology? Curr Opin Obstet Gynecol 2012; 24:273-4. [DOI: 10.1097/gco.0b013e328357e3cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Platelet function disorders and menorrhagia in adolescents: a review of laboratory diagnosis. J Pediatr Adolesc Gynecol 2012; 25:233-7. [PMID: 22840932 DOI: 10.1016/j.jpag.2012.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 11/23/2022]
Abstract
This article provides an overview of the prevalence and pathophysiology of platelet function disorders (PFDs) in adolescents with menorrhagia. In addition, this article reviews the various testing modalities employed for diagnosing PFDs including platelet aggregometry, platelet function analyzer (PFA-100), platelet electron microscopy (EM), flow cytometry, and thromboelastography (TEG), discuss their utility and drawbacks, and allude to the recent recommendations and consensus statements about some of these modalities. Finally, the authors have sketched out a diagnostic algorithm for platelet function testing, which will guide treating physicians to a step-wise approach while evaluating adolescents with menorrhagia for PFDs.
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Davidson BR, DiPiero CM, Govoni KD, Littleton SS, Neal JL. Abnormal Uterine Bleeding During the Reproductive Years. J Midwifery Womens Health 2012; 57:248-54. [DOI: 10.1111/j.1542-2011.2012.00178.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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