Dysfunctional Uterine Bleeding in Pediatrics Follow-up
- Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Andrea L Zuckerman, MD more...
Further Outpatient Care
Consider long-term (≥ 6 months) suppression of the hypothalamic-pituitary-ovarian (HPO) axis in patients with bleeding that results in significant anemia. Mild anemia responds rapidly to once-daily oral iron supplementation. Iron supplements taken orally two or three times daily can cause constipation with subsequent noncompliance and should be avoided in most patients if possible.
Further Inpatient Care
Patients require admission for acute poorly controlled bleeding that results in severe symptomatic anemia. Consider transfusion of packed red blood cells for these patients.
Place patients with a history of DUB and no desire for attempting conception on oral contraceptive pills or cyclic progestins for cycle control. A backup birth control method (eg, condom use) is recommended.
Complications are related to acute or chronic blood loss and the resulting anemia. Observe patients who receive blood products for the usual transfusion-related complications of acute hemolytic reactions, bacterial sepsis, and viral infections.
Adolescents with DUB have an excellent prognosis, and most outgrow the problem within 3-5 years of menarche. Compliant patients prescribed oral contraceptive pills rarely have recurrent episodes of DUB. For patients with DUB related to systemic disease, the prognosis depends upon the underlying illness.
Instruct the patient and her caregivers about the normal menstrual cycle and the generally benign nature of DUB. Recommend recording a calendar history of menstrual cycles, noting the beginning and end dates of bleeding. Advise patients to return if bleeding is recurrent or does not respond to medical therapy.
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