Abnormal Uterine Bleeding in the Adolescent

Abnormal uterine bleeding (AUB) is a common menstrual symptom among female adolescents. The American College of Obstetricians and Gynecologists has championed using the menstrual cycle as a vital sign, with abnormal menstruation patterns triggering work-up of potential health concerns.1,2 The average age of menarche has remained stable at approximately 12–13 years over the past 80 years in well-nourished populations in developed countries.3 Irregular cycles occur most frequently within the first 2–3 years after menarche. Although this is normal during this timeframe, cycle length still should be approximately 21–45 days, with menses lasting 2–7 days. Normal blood loss is 30 mL per cycle or three to six pads or tampons per day (Box 1).1,4,5 Heavy menstrual bleeding refers to cycles lasting more than 7 days or a blood loss of greater than 80 mL per menses. Additionally, blood loss affecting quality of life and adolescent well-being warrants investigation.6 Because adolescents often do not quantify volume of menstruation very well, changing a sanitary product every 1–2 hours has been deemed excessive, especially if menses is longer than 7 days.1 INCIDENCE Abnormal uterine bleeding affects 3–20% of reproductive-aged females, with a higher incidence in adolescence.7 Heavy menstrual bleeding is the most frequent symptom. In a population-based study of 1,000 healthy Swedish adolescents, 73% reported menstrual problems and 37% reported heavy menstrual bleeding.8 Other population-based studies have reported that 12.1% and 17.9% of adolescents experienced heavy menstrual bleeding in Nigeria and Hong Kong, respectively.9,10

Hernandez A, Dietrich JE. Abnormal Uterine Bleeding in the Adolescent. Obstet Gynecol. 2020 Mar;135(3):615-621. doi: 10.1097/AOG.0000000000003693. PMID: 32028485.

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