Description
Abnormal Uterine Bleeding (AUB) in Adolescents is a common yet often challenging condition that requires careful evaluation to distinguish physiological causes from underlying pathology. This webinar will explore the etiologies, diagnostic approaches, and evidence-based management strategies for AUB in adolescent patients. Emphasis will be placed on hormonal regulation, screening for coagulopathies, and individualized treatment plans to ensure optimal reproductive and overall health. The session will also highlight practical clinical insights and case-based discussions to aid healthcare professionals in effective patient care.
Summary Listen
- The speaker addresses the issue of unscientific advice given to adolescent girls regarding menstrual irregularities, emphasizing the importance of evidence-based solutions. He and his wife often reassure mothers that irregular cycles are expected during puberty, highlighting specific timelines and patterns for when investigation and management become necessary post-menarche. Primary amenorrhea should be investigated if it persists beyond age 15 or three years after thelarche.
- Early menarche (age 9-10) is considered normal due to societal development and prosperity, and is typically self-limiting. The speaker also corrects the misconception that height growth ceases with menstruation, assuring young girls that height can still increase after menarche. Heavy or prolonged menstrual bleeding warrants investigation for potential bleeding disorders like Von Willebrand disease or platelet function defects.
- The presentation discusses the management of AUB (Abnormal Uterine Bleeding) with thin endometrium and folliculogenesis, suggesting supplementation with COCs (combined oral contraceptives) or estrogen followed by progesterone. Conversely, thick endometrium due to excessive estrogen requires neutralization with progesterone, initially using 19-North testosterone derivatives for immediate arrest followed by 19-North progesterone derivatives for maintenance.
- The speaker addresses cases of secondary amenorrhea, recommending investigation for prolactin or thyroid hormone imbalances. PCOS (Polycystic Ovary Syndrome) diagnosis in adolescents requires both irregular menstrual cycles and hyperandrogenism, with a confident diagnosis best made three to four years post-menarche. Sonography is not recommended for PCOS diagnosis in adolescents.
- Clinical hyperandrogenism can be diagnosed through standardized visual scales like the Ferriman-Gallwey score, while lab diagnosis involves elevated serum levels of testosterone, pre-testosterone, DHEAS, or androstenedione. Lifestyle interventions are crucial, emphasizing weight management, exercise, and behavioral strategies. Treatment options for PCOS include COCPs, anti-androgens, and metformin, with metformin remaining a key medication for insulin resistance.
- Fibroids in adolescents with AUB are uncommon. Management focuses on controlling cycles with hormones first, reserving surgical intervention for large fibroids causing pressure symptoms. Recurrent pelvic pain in sexually active adolescents might indicate PID (Pelvic Inflammatory Disease) and pelvic congestion syndrome, which can be treated with progesterone in the second half of the cycle. He emphasizes the significance of understanding the underlying physiology and pharmacology for effective management of adolescent AUB.
Sample Certificate
About the Speakers
Dr. Pankaj Desai
Consultant Gynecologist, Janani Maternity Hospital, Vadodara, Gujarat
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