Clinical and etiologic characteristics of abnormal uterine bleedings in adolescent girls

Abstract

Actuality: Abnormal uterine bleedings of puberty (AUBP) are one of the most severe gynecological diseases in adolescents constituting 20-30% of all gynecological diseases in this age group. Issues of diagnosis, treatment and rehabilitation of patients with AUBP remain relevant, since recurrence worsens prognosis regarding reproductive function in these patients, which is still an important social and economic problem. The aim of our study was to evaluate clinical and etiological features of the development and presentation of new abnormal uterine bleedings in adolescents. Materials and methods: Assessment of medical records of 11-17-year-old adolescents with AUBP for the years 2014-2015 was performed at the Department of Obstetrics, Gynecology and Children Gynecology (Regional Children Clinical Hospital No.1 and Kharkiv Maternity Hospital No.1). Results: The study of medical records showed that 70% of patients developed AUBP at the age of 14-16 years, the majority of patients (77.5%) had new-onset bleedings and 22.5% of adolescents suffered from recurrent bleedings. Of these, 80% of girls did not undergo rehabilitation after the new-onset bleeding and did not seek gynecological help to restore menstrual function. The findings revealed that 55% of patients had such family histories of reproductive disorders as maternal menstrual dysfunction (MD), complicated perinatal period (hypoxia during labor, birth trauma, intrauterine pneumonia and other) in 45% of patients. The majority of patients were found to develop AUBP at unfavorable premorbid background: 67.5% of them had frequent acute respiratory viral infections and sore throat in prepubertal period. Besides, 60% of patients were diagnosed with chronic extragenital diseases (chronic gastritis, pyelonephritis, disorders of the nervous and endocrine systems). Conclusions: Thus, the study showed that AUBP more commonly occurs in adolescent girls 2-3 years after menarche. The study also determined multifactorial etiology of this disease: the impact of adverse perinatal period and premorbid background, the presence of extragenital pathology, as well as hereditary predisposition to MD. Absence of rehabilitation after new-onset bleeding is regarded as a risk factor of recurrence, which indicates the need for careful clinical examination of these patients in order to restore menstrual function during routine clinical examination.