Dysfunctional Uterine Bleeding in Pediatrics Workup

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Andrea L Zuckerman, MD   more...
 
Updated: Jul 13, 2011
 

Laboratory Studies

Focus routine laboratory studies to discover common complications and rule out serious medical conditions that can mimic dysfunctional uterine bleeding (DUB).

  • CBC count - Useful to reveal anemia, infections, and thrombocytopenia
  • Prothrombin time (PT), activated partial thromboplastin time (aPTT), and bleeding time - For possible blood dyscrasias and clotting disorders
  • Pregnancy test - Must be performed even in patients who deny sexual activity
  • Cervical cultures or urine DNA probe - To determine existence of chlamydia and gonorrhea, especially if sexual activity is suspected (The prevalence of chlamydia has historically been underestimated. In the United States, chlamydia is the most commonly reported sexually transmitted infection.[9] )
  • Reserve secondary laboratory studies for patients with abnormal bleeding; for patients who are unresponsive to therapy; and for patients with findings on history, physical examination, or laboratory studies suggestive of a systemic disorder.
  • Thyroid-stimulating hormone (TSH) test and free thyroxine concentration (fT4) -To screen for thyroid disease
  • Fasting glucose - To rule out occult diabetes
  • Prolactin - To rule out hyperprolactinemia
  • Dehydroepiandrosterone sulfate (DHEAS), free testosterone, and 17-hydroxyprogesterone (17 OHP) - To evaluate for PCOS
  • VWF:Ag (von Willebrand factor antigen), VWF:RCo (von Willebrand factor ristocetin cofactor) and factor VIII - If von Willebrand disease is suspected[10]
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Imaging Studies

Reserve pelvic imaging studies for women who do not respond to routine management.

Ultrasonography (transabdominal or transvaginal (for consideration in patients with history of sexual intercourse/tampon use) is the method of choice for evaluation of the female pelvis. It is useful for demonstrating structural abnormalities of the uterus and ovarian neoplasms.

MRI has adequate resolution but only rarely is superior to ultrasonography and is significantly more expensive.

CT scanning is useful for the workup of the rare woman in this age group with a confirmed neoplasm.

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Procedures

  • Uterine curettage is rarely indicated in the adolescent with DUB. This procedure is usually reserved for women with significant and prolonged hemorrhage unresponsive to medical therapy.
  • Diagnostic hysteroscopy can be used to look for structural abnormalities as a cause of persistent DUB.
  • Sonohysterography is a less invasive but less accurate method of evaluating the uterine cavity. The procedure consists of injecting fluid into the uterus under ultrasonographic visualization.
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Histologic Findings

Endometrial biopsy is rarely required and should be reserved for adolescents with unresponsive uterine bleeding. Endometrial curetting often demonstrates a disordered proliferative pattern without secretory activity (absence of progesterone effect). Findings of endometrial biopsies in patients who are currently receiving hormonal therapy demonstrate the hormonal effects and sometimes interfere with biopsy interpretation.

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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

Elizabeth Alderman, MD  Director of Fellowship Training Program, Director of Adolescent Ambulatory Service, 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, and Society for Adolescent Medicine

Disclosure: Merck Honoraria Speaking and teaching

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  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

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

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD  Assistant Professor of Obstetrics/Gynecology and Pediatrics, 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, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference 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.

References

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  2. Coupey SM, Ahlstrom P. Common menstrual disorders. Pediatr Clin North Am. Jun 1989;36(3):551-71. [Medline].

  3. Lavin C. Dysfunctional uterine bleeding in adolescents. Curr Opin Pediatr. Aug 1996;8(4):328-32. [Medline].

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  8. Austin SB, Ziyadeh NJ, Vohra S, Forman S, Gordon CM, Prokop LA. Irregular menses linked to vomiting in a nonclinical sample: findings from the National Eating Disorders Screening Program in high schools. J Adolesc Health. May 2008;42(5):450-7. [Medline].

  9. Toth M, Patton DL, Esquenazi B, Shevchuk M, Thaler H, Divon M. Association between Chlamydia trachomatis and abnormal uterine bleeding. Am J Reprod Immunol. May 2007;57(5):361-6. [Medline].

  10. National Heart Lung and Blood Institute (NHLBI). The Diagnosis, Evaluation and Management of von Willebrand Disease -- 2008 Clinical Practice Guidelines. National Institutes of Health. 2008;[Full Text].

  11. [Guideline] ACOG. Management of Anovulatory Bleeding. 2008 Compendium of Selected Publications. 2000;14:1049-56. [Full Text].

  12. Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. Jun 2008;35(2):219-34, viii. [Medline].

  13. Stabinsky SA, Einstein M, Breen JL. Modern treatments of menorrhagia attributable to dysfunctional uterine bleeding. Obstet Gynecol Surv. Jan 1999;54(1):61-72. [Medline].

  14. Rajput R, Dhuan J, Agarwal S, Gahlaut PS. Central venous sinus thrombosis in a young woman taking norethindrone acetate for dysfunctional uterine bleeding: case report and review of literature. J Obstet Gynaecol Can. Aug 2008;30(8):680-3. [Medline].

  15. Gultekin M, Diribas K, Buru E, Gökçeoglu MA. Role of a non-hormonal oral anti-fibrinolytic hemostatic agent (tranexamic acid) for management of patients with dysfunctional uterine bleeding. Clin Exp Obstet Gynecol. 2009;36(3):163-5. [Medline].

 
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