Abstract Ref Number = APCP72
Division of Endocrinology Dept of Child Health School of Medicine Universitas Indonesia Endocrinology Working Group Indonesian Pediatric Society
Abnormal Uterine Bleeding (AUB) is a common gynecological complaint in adolescent. AUB is any form of bleeding that is irregular in amount, duration, or frequency. Studies shows that 19% of females aged 11 to 15 had regular cycles within the first three cycles and 67% had regular cycles by the end of second year. The menstrual irregularity in most adolescent is mostly due to the immaturity of the hypothalamic-hypophyses-ovarian (HHO) axis which gradually develops 18-24 months post-menarcheal.
Even though most AUB cases in adolescent are benign, certain conditions that need serious consideration are no menstrual cycles by 3 years post thelarche, by 14 years of age with signs of hirsutism or with a history or examination suggestive of excessive exercise or eating disorder, and by 15 years of age.
The aims for caring an adolescent with AUB are to maintain hemodynamic stability, determine the etiology, normalise the menstrual cycle, minimise treatment adverse effects, and preserving fertility,
Determining the etiology is simplified by the structural or non-structural approach. The structure part consist of mnemonic PALM (polyp, adenomysosi, leiomyoma, malignancy/hyperplasia) while non structure part consist of mnemonic COEIN (coagulopathy, ovarian dysfunction, endometriosis, iatrogenic, non-classified). Most causes of AUB in adolescent are non-structure, of these 40% is due to heavy menstrual bleeding (HMB), and in which coagulopathy is prevalent (20%).
Treatment of AUB in adolescent includes hormonal, non hormonal and rarely surgery. Treatment is determined by the severity of symptoms, underlying cause, and patient’s need for contraception, adherence or compliance capabilities, and the acceptability of adverse effects, costs, and interventions. Unfortunately no guideline is available for AUB management in adolescent. Normal menstrual cycles has been regarded as a surrogate indicator of overall adolescent health, and yet only 19.7% female adolescent in Indonesia discuss reproduction health with medical personnel, while 57,6% with friends.