Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Semin Reprod Med. 2022 Mar;40(1-02):23-31. doi: 10.1055/s-0041-1739309. Epub 2021 Nov 3.
Heavy, and often irregular, menstrual bleeding (HMB) is a common gynecologic complaint among adolescents. During the first few post-menarcheal years, anovulatory cycles related to immaturity of the hypothalamic-pituitary-ovarian axis are the most common etiology for abnormal uterine bleeding and should be considered as a part of normal pubertal development rather than a disease. If an already regular menstrual cycle becomes irregular, secondary causes of anovulation should be ruled out. Inherited and acquired bleeding disorders, such as von Willebrand disease, and quantitative and qualitative abnormalities of platelets are relatively common findings in adolescents with HMB from menarche. History of excessive bleeding or a diagnosed bleeding disorder in the family supports this etiology, warranting specialized laboratory testing. First-line treatment of HMB among adolescents is medical management with hormonal therapy or nonhormonal options. Levonorgestrel-releasing intrauterine device is an effective tool also for all adolescents with menstrual needs.
月经过多（HMB）是青少年常见的妇科主诉，常伴有月经不规律。初潮后的最初几年，由于下丘脑-垂体-卵巢轴不成熟导致的无排卵周期是异常子宫出血的最常见病因，应将其视为青春期正常发育的一部分，而不是疾病。如果已经规律的月经周期变得不规律，则应排除无排卵的继发原因。遗传性和获得性出血性疾病，如血管性血友病，以及血小板的数量和质量异常，在初潮后 HMB 的青少年中较为常见。家族中月经过多或已确诊的出血性疾病史支持这种病因，需要进行专门的实验室检查。青少年 HMB 的一线治疗是采用激素治疗或非激素治疗的医学管理。左炔诺孕酮宫内释放系统也是所有有月经需求的青少年的有效工具。
