DYSFUNCTIONAL UTERINE BLEEDING IN ADOLESCENT AND TEENAGE GIRLS

Dysfunctional uterine bleeding in adolescent girls is a common problem that faces many gynecologists in their practice. The underlying etiology is hypothalamic pituitary dysfunction leading to anovulatory cycles. The endometrium is under unopposed estrogen effect that stimulates proliferative changes and increases its thickness. This eventually leads to disintegration of the endometrium in certain areas with bleeding episodes. It is essential to reach the correct diagnosis by proper history, physical examination, and hematologic and endocrine studies. The treating physician has to rule out pregnancy, liver disease, kidney disease, pelvic tumors, and endocrine problems including thyroid disease, hyperprolactinemia, and hyperandrogenism. Furthermore, coagulation studies should be included to rule out defects in coagulation factors such as idiopathic thrombocytopenia and von Willebrand's disease. Dysfunctional uterine bleeding is usually treated hormonally with progestins in cyclic fashion. This treatment is effective in patients with chronic bleeding episodes. In patients with heavy bleeding, intravenous estrogen treatment has been effective in controlling the acute episode of bleeding followed by progestin treatment. If hormonal treatment fails, these patients should have hysteroscopic evaluation of the uterine cavity to rule out intrauterine lesions such as polyps, submucous fibroids, and arteriovenous malformations.