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Dysfunctional Uterine Bleeding in Pediatrics Follow-up

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Andrea L Zuckerman, MD  more...
 
Updated: Apr 20, 2015
 

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.

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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.

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Deterrence/Prevention

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.

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Complications

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.

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Prognosis

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.

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Patient Education

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.

For patient education resources, see the Women's Health Center, as well as Vaginal Bleeding, Amenorrhea, Anemia, and Painful Ovulation (Mittelschmerz).

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Contributor Information and Disclosures
Author

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD Associate Professor of Obstetrics/Gynecology, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Additional Contributors

Elizabeth Alderman, MD Director, Pediatric Residency Program, Director of Fellowship Training Program, Adolescent Medicine, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous authors Tod C Aeby, MD, and LeighAnn C Frattarelli, MD, MPH, to the development and writing of this article.

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