ESPE Abstracts

Background: Abnormal uterine bleeding is a common complaint among adolescents, however, there are no evidence-based guidelines for their treatment, and there is a paucity of outcome data available.

Objectives: To describe the characteristics of adolescents with menstrual abnormalities and to describe management protocol outcomes.

Methods: This is a retrospective study, based on information from medical records of patients aged 10-18 years, evaluated in the integrated adolescents gynecology-endocrinology clinic at the Shamir (Assaf Harofe) medical center in Israel for abnormal uterine bleeding from January 2007 to December 2020. Management protocols included cyclic oral progesterone (CyP), oral contraceptives (OCP), Metformin and Tranexamic acid (TA).

Results: One hundred and twenty-three teens were evaluated for abnormal menses, including heavy bleeding in 46.3%, oligomenorrhea in 32.5%, primary amenorrhea in 13.8%, and secondary amenorrhea in 7.3%. Following evaluation, 54 teens were diagnosed with polycystic ovary syndrome (PCOS), 34 with heavy menstrual bleeding (HMB), 7 with primary ovarian insufficiency (POI), and 7 with hypothalamic-pituitary insufficiency (HPI). Menstrual abnormalities resolved over time in 21 teens, diagnosed with an immature axis. Those with PCOS were older, presented more frequently with oligomenorrhea, had a higher body mass index (BMI), and a higher degree of hirsutism. A third of them needed to switch from CyP to OCP. Patients with HMB had significantly lower hemoglobin and were mainly treated with TA.

Conclusions: Management choices for adolescents with abnormal uterine bleeding should depend on age, blood count parameters, and etiology. Teens diagnosed with PCOS may be offered CyP or OCP, while oral TA should be offered to teens with HMB.