REVIEW   

Minerva Ginecologica 2017 December;69(6):618-30

DOI: 10.23736/S0026-4784.17.04090-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: Italian

Differential diagnosis and management of abnormal uterine bleeding in adolescence

Tiziano MOTTA ¹, Antonio S. LAGANÀ ², Gaetano VALENTI ³, Valentina L. LA ROSA ⁴ ✉, Marco NOVENTA ⁵, Amerigo VITAGLIANO ⁵, Benito CHIOFALO ², Agnese M. RAPISARDA ³, Diego ROSSETTI ⁶, Salvatore G. VITALE ²

¹ Department of Obstetrics and Gynecology, Luigi Mangiagalli Institute, University of Milan, Fondazione IRCSS Cà Granda, Maggiore Polyclinic Hospital, Milan, Italy; ² Unit of Obstetrics and Gynecology, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy; ³ Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy; ⁴ Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy; ⁵ Department of Woman and Child Health, University of Padua, Padua, Italy; ⁶ Unit of Obstetrics and Gynecology, Desenzano del Garda Hospital, Gavardo, Brescia, Italy

Abnormal uterine bleeding (AUB) is defined as any atypical genital bleeding originating from the uterine cavity, without the characteristics of normal menstrual period. AUB is an important symptom both for adolescents and their parents, and it usually leads to a state of anxiety. Although about 95% of AUB could be considered as a dysfunctional disorder, AUB requires well-defined diagnostic procedures in order to detect a physical cause, ruling out complex or systemic diseases, including oncological ones. Diagnostic procedures require the acquisition of a full and detailed history, and it is also crucial to obtain as much compliance from the patient as possible. A complete gynecological evaluation (whenever possible) and a full physical examination are useful to detect any kind of general disease which can compromise the hormonal reproductive system. Auxiliary tools such as gynecological ultrasonography for pelvic examination are allowed in sexually-active women, otherwise transrectal ultrasonography could be considered, if needed. Hematic β-hCG must be dosed in every fertile woman with AUB and laboratory tests must be tailored on each patient. The first-line treatment consists of combined oral contraceptives and, when they are contraindicated, progesterone alone, medicated intrauterine devices, GnRH-analogues, or desmopressin are the most common second-line treatments.

KEY WORDS: Metrorrhagia - Adolescent - Diagnosis - Therapeutics