Serviço de Ginecologia/Obstetrícia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
Acta Med Port. 2021 Mar 31;34(4):291-297. doi: 10.20344/amp.12829. Epub 2021 Apr 1.
Abnormal uterine bleeding is the most common complaint that motivates female adolescents to seek medical advice. Abnormal uterine bleeding has a significant impact on quality of life, promoting school absenteeism and limitations in social life. Moreover, episodes can vary from mild to life threatening events if not recognized and treated promptly. Healthcare providers should be able to distinguish between a normal and abnormal menstrual pattern, as this may provide early diagnosis of a potential health concern. The PALM-COEIN classification system should be used in the evaluation. Anovulation is the most frequent cause, frequently due to immaturity of the hypothalamic-pituitary-ovarian axis. A careful history and physical examination are crucial in the differential diagnosis. Management is based on both the underlying cause and the severity of bleeding. Most patients improve with pharmacological treatment, frequently requiring a multidisciplinary approach. First line treatment consists of hormonal therapy. Surgery is rarely needed. Although the prevalence of abnormal uterine bleeding is higher in adolescents compared to adults, most recommendations are not specific for this age, which makes the diagnosis and management challenging. The literature reveals lack of standardized care for adolescents and regimens vary widely. Future studies on efficacy and safety of treatments specifically in adolescents are needed.
异常子宫出血是促使青春期女性寻求医疗建议的最常见主诉。异常子宫出血对生活质量有重大影响，导致学生缺课和社交生活受限。此外，如果不能及时识别和治疗，出血事件可能从轻症到危及生命。医疗保健提供者应该能够区分正常和异常的月经模式，因为这可能有助于及早诊断潜在的健康问题。应使用 PALM-COEIN 分类系统进行评估。无排卵是最常见的原因，通常是由于下丘脑-垂体-卵巢轴不成熟所致。仔细的病史和体格检查对鉴别诊断至关重要。治疗基于潜在原因和出血的严重程度。大多数患者通过药物治疗改善，通常需要多学科方法。一线治疗包括激素治疗。很少需要手术。尽管异常子宫出血在青少年中的患病率高于成年人，但大多数建议并非专门针对这一年龄段，这使得诊断和管理具有挑战性。文献显示，青少年的异常子宫出血缺乏标准化治疗，方案差异很大。需要针对青少年进行特定治疗的疗效和安全性的未来研究。
