Exam Question of the Day
Which of the following is the least common etiology of abnormal uterine bleeding during adolescence?
B. Endometrial hyperplasia
D. Bleeding disorder
E. Sexually transmitted infection
Answer B - Practice Bulletin Number 136 July 2013
Anovulation is the most common etiology of abnormal uterine bleeding during adolescence. During the first 12-18 months after the onset of menstruation, the immaturity of the HPO axis is frequently the cause of AUB-O. Obesity is becoming an increasingly important contributor to anovulatory cycles in adolescents. The differential diagnosis of AUB in adolescents is quite similar to that of other age groups except that the risk of endometrial hyperplasia and malignancy is extremely low. Patients with AUB-O can have a concomitant bleedign disorder. Von Williebrand disease is the most common bleeding disorder in women. Adolescent who require hospitalization ( HGB less than 10g/dL) or require blood transfusion have a 20-30% risk of coagulopathy. Pregnancy, sexual trauma, and sexually transmitted infections must be ruled out initially regardless of reported sexual history. Patients also should be evaluated for PCO by assessing signs of hyper androgenism, such as acne and hirsutism on PE.