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Chapter 3 Index
A. General
B. Skin
C.
Orthopedics
D.
Genitourinary:
--Hormonal
Contraception for Adolescents
--Dysmenorrhea |
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Dysfunctional Uterine Bleeding
Reda Bassali, MD
Definition: Prolonged bleeding from the uterine endometrium
that is unrelated to an organic lesion. Bleeding is painless and irregular.
Secondary to anovulatory cycles which can occur in 50% of adolescents
following menarche.
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Issue |
Normal |
Abnormal: Hgb must be checked! |
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Duration of flow |
2-8 days |
< 2 days; > 8 days |
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Cycle length |
21-40 days |
< 21 days; > 40 days |
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Blood loss |
20-80 cc (avg 30cc) |
> 80 cc |
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Length of time irregular |
Up to 2 years (anovulatory) |
> 2 years |
Differential Diagnosis of Dysfunctional Uterine
Bleeding: 1/4 hospitalized adolescents = organic
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Pregnancy complications: Ectopic, Abortion
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Genital Infections: Vaginitis, Cervicitis, PID, and
Foreign Body
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Endocrinopathies: Thyroid, hyperprolactinemia
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Drugs: Oral contraceptives (missed pills); seizure
medications
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Coagulation disorders such as VW disease, ITP.
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Neoplasms: cervical polyps, leiomyoma, and carcinoma
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Chronic Illness: liver failure, renal failure
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Hypothalamic dysfunction: stress, excessive exercise,
weight loss.
Laboratory Workup of Dysfunctional Uterine
Bleeding:
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CBC - must check Hemoglobin: if < 12 = moderate; if <
10 gms = severe.
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Pregnancy test
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PT, PTT, Bleeding time, VW factor level
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If chronic anovulation: LH/FSH
Treatment:
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Education, explanation, reevaluate periodically
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If mild (Hemoglobin > 12): treat with oral
contraceptives if sexually active only reassurance if not sexually active
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If moderate (Hemoglobin between 10 and 12): give
iron, oral contraceptives (Ovral) combine with treatment with NSAIDs (see
dysmenorrhea chart)
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If severe (Hemoglobin < 10): May need to hospitalize,
transfuse, and give iron. Give oral contraceptives q 6 hours until
bleeding stops x 24 hours then taper to 1x/day over 5-7 days. Give IV
Premarin
Written 5/01
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