Adolescents

In adolescents the three most common presentations of abnormal vaginal bleeding are anovulation, menorrhagia, and amenorrhea. It is normal for menstrual cycles to be anovulatory for an average of 18 months after menarche in adolescents while the hypothalamic-pituitary axis matures. Menorrhagia (heavy bleeding) is quite common in adolescent patients and is most often caused by anovulation (Rim-sza, 2002). In some young women, however, menorrhagia at menarche can be a sign of a bleeding disorder. Up to 24% of adolescents with menorrhagia may have an undiagnosed bleeding disorder (Strickland, 2004). Evaluation of men-orrhagia in adolescents includes a complete blood count (CBC), coagulation profile, and von Willebrand's screening test if clinically indicated. Treatment of both anovulation and menorrhagia in adolescents is usually hormonal contraception for cycle control.

The most common causes of primary amenorrhea include pregnancy, chromosomal abnormalities, (e.g., Turner's or Sawyer's syndrome); hypothalamic hypogonadism; congenital absence of the uterus, cervix, or vagina; and structural abnormalities (e.g., transverse vaginal septum or imperforate hymen). Evaluation of primary amenorrhea includes a careful history, pelvic examination, pelvic ultrasound to document the presence of pelvic organs, and chromosome analysis if clinically indicated.

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