Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; and the Department of Obstetrics and Gynecology, UCSF Fresno, Fresno, California.
Obstet Gynecol. 2020 Mar;135(3):615-621. doi: 10.1097/AOG.0000000000003693.
Abnormal uterine bleeding is a common problem in adolescents. The differential diagnosis varies from pregnancy and infection to anovulation and coagulopathy. Careful history and examination can help elucidate the best next steps for workup and management. Heavy menstrual bleeding is particularly worrisome in this group not only when it occurs at menarche, but also anytime afterward when bleeding lasts longer than 7 days, blood loss is greater than 80 mL per cycle, or other warning signs that indicate a history of heavy bleeding such as anemia. Once conditions of pregnancy, infection, structural abnormalities, and hormonal causes have been ruled out, first-line treatment is medical management with hormonal therapy or nonhormonal options. Invasive measures are a last resort in this patient population, because maintenance of fertility is of critical importance.
异常子宫出血是青少年的常见问题。鉴别诊断范围从妊娠和感染到无排卵和凝血障碍。仔细的病史和检查有助于阐明进一步检查和管理的最佳步骤。在这组人群中，月经过多不仅在初潮时令人担忧，而且在任何时候，只要出血持续超过 7 天，出血量大于每周期 80 毫升，或有其他表明有大量出血史的警告信号，如贫血。一旦排除了妊娠、感染、结构异常和激素原因，一线治疗是采用激素治疗或非激素治疗进行医学管理。在这一患者群体中，侵入性措施是最后的手段，因为维持生育能力至关重要。
