Talib Hina J, Coupey Susan M
Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
Adolesc Med State Art Rev. 2012 Apr;23(1):53-72.
Menstrual bleeding that falls outside the range of normal in adolescents is often a cause of great concern for both girls and their families. Often, much of this anxiety can be alleviated with proper anticipatory guidance about menarche and early menstrual bleeding patterns. Eliciting a menstrual history from an adolescent girl is challenging, and the use of concrete methods to chart their patterns and flow, such as menstrual calendars and pictorial bleeding assessment calendar (PBAC) tools, may be helpful. The importance of obtaining a confidential history from the adolescent girl cannot be overestimated. A confidential sexual history is essential so that pregnancy and infectious causes of bleeding are addressed. Not all menstrual bleeding in young girls is attributable to immaturity of the HPO axis. Anovulation and DUB from other clinically relevant conditions in adolescent girls must also be considered. Chief among these is PCOS, which should always be ruled out when a girl presents with excessive bleeding associated with clinical signs of hyperandrogenism, obesity, or insulin resistance. Attention must also be paid to signs or a family history of a bleeding disorder, as vWD is commonly associated with excessive uterine bleeding. Importantly, the laboratory testing for both PCOS and vWD is affected by therapies for the excessive bleeding, and it should be performed before hormonal interventions or blood products are administered or during the placebo phase if treatment has begun. Management goals for excessive uterine bleeding include stabilizing the endometrium and stopping further blood loss, as well as preventing future uncontrolled blood loss. Hormonal stabilization of the endometrium is often helpful regardless of the cause of bleeding and especially in those with hormonally mediated anovulation. New antifibrinolytics, such as tranexamic acid, may also be helpful in the emergent setting and in adolescents with bleeding disorders.
青少年月经出血超出正常范围往往会让女孩及其家人极为担忧。通常，通过对初潮和早期月经出血模式进行适当的预期指导，这种焦虑情绪大多可以得到缓解。从青春期女孩那里获取月经史具有挑战性，使用诸如月经日历和图像式出血评估日历（PBAC）工具等具体方法来记录她们的月经模式和出血量可能会有所帮助。从青春期女孩那里获取保密病史的重要性再怎么强调也不为过。保密的性病史至关重要，这样才能排查出血的妊娠和感染性原因。并非所有年轻女孩的月经出血都归因于下丘脑-垂体-卵巢（HPO）轴不成熟。青春期女孩因其他临床相关病症导致的无排卵和功能失调性子宫出血（DUB）也必须予以考虑。其中最主要的是多囊卵巢综合征（PCOS），当女孩出现与高雄激素血症、肥胖或胰岛素抵抗的临床体征相关的过多出血时，必须始终排除该病症。还必须注意出血性疾病的体征或家族史，因为血管性血友病（vWD）通常与子宫出血过多有关。重要的是，PCOS和vWD的实验室检测会受到过多出血治疗方法的影响，应在进行激素干预或输注血液制品之前进行，或者如果已经开始治疗，则在安慰剂阶段进行。子宫出血过多的管理目标包括稳定子宫内膜、停止进一步失血，以及防止未来出现失控性失血。无论出血原因如何，尤其是对于那些由激素介导的无排卵患者，子宫内膜的激素稳定通常会有所帮助。新型抗纤维蛋白溶解剂，如氨甲环酸，在紧急情况下以及患有出血性疾病的青少年中可能也会有所帮助。
