DYSFUNCTIONAL UTERINE BLEEDING IN ADOLESCENTS

This retrospective, multicenter analysis teas conducted on all adolesc ents admitted to three pediatric hospitals in Montreal, Quebec, Canada , over a 10-year period (1981-1991) with a primary diagnosis of dysfun ctional uterine bleeding. The purpose was to assess the frequency of u nderlying medical disorders and their response to medical therapy. Six ty-one patient charts were identified. Newly diagnosed hematologic abn ormalities were found in two patients (one with immune thrombocytopeni c purpura and one with acute promyelocytic leukemia). Furthermore, all patients who were evaluated had normal factor VIII levels, partial th romboplastin times and prothrombin times. Twenty-nine percent of the p atients had a past history of a significant medical problem. The mean age at presentation was 13.8 +/- 2.1 (SD) years. More than 50% of the patients had a history of irregular bleeding. Most patients (93.4%) re sponded to medical management. Only five (8.2%) required dilation and curettage. The history of irregular cycles, the early presentation aft er menarche, the infrequency of hematologic problems but high frequenc y of significant medical problems led us to conclude that the etiology of dysfunctional uterine bleeding in adolescence is often related to persistent immaturity of the hypothalamic-pituitary-ovarian axis. Medi cal therapy is highly effective in controlling such bleeding. Dilation and curettage is rarely required.