Evaluation of the Management of Adolescents with Abnormal Uterine Bleeding with a Multidisciplinary Approach

Yıl 2024, Cilt: 46 Sayı: 6, 972 - 980, 07.11.2024

Mehtap Ertekin , Ferda Evin , İlkay Ayrancı

https://doi.org/10.20515/otd.1505197

Öz

Abnormal uterine bleeding (AUB) refers to atypical uterine corpus bleeding characterized by duration, volume, frequency, and/or pattern deviations. It represents a prevalent gynecological endocrine issue among adolescents. This retrospective study analyzed data from 40 adolescent patients diagnosed with AUB. Severity of AUB was categorized based on hemoglobin levels: mild (10-12 g/dL), moderate (8-9.9 g/dL), and severe (<8 g/dL). The mean age of the cohort was 14.38±2.1 years (range: 11-17.8 years). Median menstrual cycle interval was 25 days (range: 10-45 days), median bleeding duration was 10 days (range: 4-35 days), and mean sanitary pad usage was 6.2 pads per day. Severe AUB was observed in 17.5% (n=7) of cases, moderate AUB in 20% (n=8), and mild AUB in 62.5% (n=25). Mild Von Willebrand Disease was diagnosed in 5% (n=2) of patients. Anovulation was the predominant etiological factor in 34 cases. Treatment protocols varied based on AUB severity. Non-steroidal anti-inflammatory drugs (NSAIDs) constituted the initial therapy for mild AUB. Adolescents with moderate AUB (n=8) and those with mild AUB unresponsive to NSAIDs (n=6) were prescribed combined oral contraceptives (COCs) containing 3mg drospirenone and 30 mcg ethinylestradiol. Severe AUB cases commenced COC therapy at escalated dosages (2-3 daily tablets), supplemented with oral tranexamic acid when bleeding remained uncontrolled. In conclusion, excessive and prolonged bleeding during adolescence poses both gynecological and social challenges. Comprehensive evaluation by pediatric endocrinologists and pediatric hematologists is essential for effective multidisciplinary treatment planning.

Anahtar Kelimeler

abnormal uterine bleeding, anemia, Von Willebrand Disease

Proje Numarası

1531

Anormal Uterin Kanamalı Adölesanların Multidisipliner Yaklaşım ile Yönetiminin Değerlendirilmesi

Öz

Anormal uterin kanama (AUK), uterus korpusundan süre, miktar, sıklık ve/veya düzen açısından anormal olan kanama olarak tanımlanır. Adölesan dönemde en sık karşılaşılan jinekoendokrinolojik problemdir. Çalışmamızda AUK olan 40 adölesanın verileri retrospektif olarak incelendi. Hemoglobin 10-12 gr/dL hafif AUK; hemoglobin 8-9,9 gr/dL orta AUK; hemoglobin <8 gr/dL ağır AUK olarak sınıflandırıldı. Olguların yaş ortalaması 14,38±2,1 (11-17,8) yıldı. Olguların ortanca menstrual siklus aralığı 25 (10-45) gün, ortanca kanama süresi 10 (4-35) gün, ortalama ped sayısı 6,2 ped/gün idi. Olguların %17.5’inde (n=7) ağır AUK, %20’sinde (n=8) orta AUK, %62,5’inde (n=25) hafif AUK mevcuttu. 2 (%5) olguda hafif Von Willebrand Hastalığı saptandı. Kanama etiyolojisinde saptanan en sık etken anovulasyondu (n=34). Hafif AUK olan olgularda kanamaya yönelik tedavide ilk seçenek olarak non-steroid antiinflamatuar ilaçlar (NSAİİ) başlandı. Orta AUK olan adölesanlara (n=8) ve hafif AUK olup NSAİİ ile kanamaları kontrol altın alınamayan olgulara (n=6) 3mg drospirenon ve 30 mcg etinilöstradiol içeren kombine oral kontraseptif (KOK) başlandı. Bu olguların kanamaları KOK ile kontrol altına alındı. Ağır AUK olan olgulara, 3mg drospirenon ve 30 mcg etinilöstradiol içeren KOK günde 2-3 tablet olacak şekilde başlandı. Bu olguların kanamalarının kontrol altına alınamaması nedeniyle tedavilerine traneksamik asit oral olarak eklendi. Ağır AUK olan tüm olgularda kombine tedavi ile kanamalar kontrol altına alındı. Sonuç olarak; adölesan dönemde aşırı ve uzun süreli kanama sadece jinekolojik bir sorun değil, aynı zamanda sosyal bir sorundur. Bu nedenle hastalar çocuk endokrinoloji ve çocuk hematoloji tarafından kapsamlı olarak değerlendirilmeli ve tedavileri multidisipliner olarak planlanmalıdır.

Anahtar Kelimeler

anormal uterin kanama, anemi, Von Willebrand Hastalığı

Etik Beyan

Etik Kurul onayı (Bakırçay Üniversitesi Etik Kurulu Karar no:1531, Tarih: 27.03.2024) ve olgulardan ve ebeveynlerinden bilgilendirilmiş onam alındı. Tüm prosedürler etik standartlara ve iyi klinik uygulama rehberliğine uygun olarak gerçekleştirildi.

Proje Numarası

1531

Teşekkür

Yazarlar bu çalışma için finansal destek almadıklarını beyan etmişlerdir.

Kaynakça

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