Skip to main content
SpringerLink
Log in

Irregular Menses

  • Chapter
  • First Online:
Endocrine Conditions in Pediatrics

  • 1172 Accesses

Abstract

Abnormal uterine bleeding (AUB) is defined as bleeding from the uterus that is abnormal in duration, volume, frequency, and/or regularity. Normal menstrual cycles in adolescents are defined as occurring every 21–45 days, with duration less than 8 days and normal flow. A history, physical examination, and pertinent laboratory evaluation are key to determining the etiology of AUB, and to identifying women with hemodynamic instability related to heavy menstrual bleeding (HMB) who require inpatient management. Pregnancy and sexually transmitted infection must be ruled out. Women with HMB and pertinent history concerning for bleeding disorder should have a workup for coagulopathy. The treatment of AUB is dependent on the etiology, and if an endocrine disorder is identified, the treatment is disorder-specific. Outpatient acute AUB is managed with high-dose oral contraceptive pills (OCP) (with anti-emetics) or progestin preparations. Chronic treatment of AUB involves OCPs and progestin-only methods, including a progestin-releasing intrauterine device (IUD).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ACOG:

American College of Obstetricians and Gynecologists

AUB:

Abnormal uterine bleeding

FIGO:

International Federation of Gynecology and Obstetrics

FSH:

Follicle-stimulating hormone

HMB:

Heavy menstrual bleeding

IMB:

Intermenstrual bleeding

IUD:

Intrauterine device

LH:

Luteinizing hormone

NAAT:

Nucleic acid amplification testing

OCP:

Oral contraceptive pill

PBAC:

Pictorial Bleeding Assessment Chart

TSH:

Thyroid-stimulating hormone

References

  1. Munro MG, Critchley HOD, Fraser IS, Committee FMD. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393–408.

    Article  Google Scholar 

  2. Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod. 2007;22(3):635–43.

    Article  Google Scholar 

  3. Fraser IS, Critchley HO, Munro MG, Broder M, Writing Group for this Menstrual Agreement Process. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007;87(3):466–76.

    Article  Google Scholar 

  4. Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017;40:3–22.

    Article  Google Scholar 

  5. American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118(5):2245–50.

    Article  Google Scholar 

  6. Flug D, Largo RH, Prader A. Menstrual patterns in adolescent Swiss girls: a longitudinal study. Ann Hum Biol. 1984;11(6):495–508.

    Article  CAS  Google Scholar 

  7. Practice Committee of American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril. 2004;82(Suppl 1):S33–9.

    Google Scholar 

  8. Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10(3):183–94.

    Article  Google Scholar 

  9. Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3–13.

    Article  Google Scholar 

  10. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206.

    Article  Google Scholar 

  11. Pecchioli Y, Oyewumi L, Allen LM, Kives S. The utility of routine ultrasound in the diagnosis and management of adolescents with abnormal uterine bleeding. J Pediatr Adolesc Gynecol. 2017;30(2):239–42.

    Article  Google Scholar 

  12. Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding. ACOG COMMITTEE OPINION, Number 785. Obstet Gynecol. 2019;134(3):e71–83.

    Article  Google Scholar 

  13. Committee on Adolescent Health C, Committee on Gynecologic P. Committee Opinion No.580: von Willebrand disease in women. Obstet Gynecol. 2013;122(6):1368–73.

    Article  Google Scholar 

  14. Bennett AR, Gray SH. What to do when she’s bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents. Curr Opin Pediatr. 2014;26(4):413–9.

    Article  Google Scholar 

  15. Gray SH. Menstrual disorders. Pediatr Rev. 2013;34(1):6–17; quiz 8.

    Article  Google Scholar 

  16. Wilkinson JP, Kadir RA. Management of abnormal uterine bleeding in adolescents. J Pediatr Adolesc Gynecol. 2010;23(6 Suppl):S22–30.

    Article  Google Scholar 

  17. Deligeoroglou E, Karountzos V, Creatsas G. Abnormal uterine bleeding and dysfunctional uterine bleeding in pediatric and adolescent gynecology. Gynecol Endocrinol. 2013;29(1):74–8.

    Article  Google Scholar 

  18. Matteson KA, Munro MG, Fraser IS. The structured menstrual history: developing a tool to facilitate diagnosis and aid in symptom management. Semin Reprod Med. 2011;29(5):423–35.

    Article  Google Scholar 

  19. Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97(8):734–9.

    Article  CAS  Google Scholar 

  20. Ott MA, Sucato GS. Contraception for adolescents. Pediatrics. 2014;134(4):e1244–56.

    Article  Google Scholar 

  21. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol. 1981;140(7):815–30.

    Article  CAS  Google Scholar 

  22. Kouides PA, Conard J, Peyvandi F, Lukes A, Kadir R. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril. 2005;84(5):1345–51.

    Article  Google Scholar 

  23. Workowski KA. Centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61(Suppl 8):S759–62.

    Article  Google Scholar 

  24. Carmina E, Rosato F, Janni A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab. 2006;91(1):2–6.

    Article  CAS  Google Scholar 

  25. Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(9):4133–60.

    Article  CAS  Google Scholar 

  26. American College of Obstetricians and Gynecologists. Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women. Obstet Gynecol. 2014;124(1):193–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Endocrinology, Hasbro Children’s Hospital/Warren Alpert Medical School of Brown University, Providence, RI, USA

    Meghan E. Fredette

Authors
  1. Meghan E. Fredette
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meghan E. Fredette .

Editor information

Editors and Affiliations

  1. Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Takara Stanley

  2. Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Madhusmita Misra

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fredette, M.E. (2021). Irregular Menses. In: Stanley, T., Misra, M. (eds) Endocrine Conditions in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-52215-5_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-52215-5_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52214-8

  • Online ISBN: 978-3-030-52215-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation