Bleeding In Adolescents Research Articles

Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis

Objective To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes. Material and methods In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10–16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual. Results 144 and 159 adolescents with JIA were evaluated according to OHI-S and GBI; corresponding numbers of controls were 154 and 161. Plaque and gingival bleeding were more frequent in individuals with JIA than controls. Adjusted analyses showed association between JIA status and OHI-S > 0 (OR = 2.33, 95% CI: 1.47 − 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 − 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups. Conclusions Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.

Risk-Adapted Approach to Levonorgestrel-Containing Intrauterine Devices Placement for Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders [A92

INTRODUCTION: Females with inherited bleeding disorders (IBD) are disproportionately affected by reproductive tract bleeding, and can suffer adverse physical, social, and emotional outcomes. Recent guidelines advise development of perioperative management protocols for women undergoing invasive procedures, but do not provide specific guidance and rely on provider-level expertise. Optimizing the care of these patients requires a multidisciplinary approach. METHODS: Patients with known/suspected bleeding disorders present to the women and girls’ bleeding disorder clinic for evaluation and counseling. A collaborative protocol is generated by hematologists and gynecologists for the patients who desire levonorgestrel-containing intrauterine devices (LNG-IUD). A periprocedural hemostatic treatment protocol is tailored to the patient’s bleeding disorder. Ultrasound is performed in advance for uterine size and device selection. Placement is performed under ultrasound guidance in an operative setting without the use of a tenaculum. In instances where patients have severe bleeding histories or ongoing vaginal bleeding at the time of LNG-IUD placement, they may elect to use anti-fibrinolytics or continue an additional form of menstrual management such as combined oral contraceptive pills (OCPs) for one to three menstrual cycles to decrease the risk of heavy bleeding and expulsion. Patients then have a short-interval follow-up for monitoring. RESULTS: Eighteen patients, ages 10-19 years, underwent LNG-IUD placement in the operating room without complications such as hemorrhage or uterine perforation. None of the patients required any further hematologic interventions that were outside the protocols as outlined preoperatively. CONCLUSION: Highly efficacious heavy menstrual bleeding (HMB) treatment can be offered to persons with IBD via a multidisciplinary approach to assure patient safety and satisfaction.

Evaluation and management of acute abnormal uterine bleeding in adolescents: oral contraceptive pill taper versus single-dose therapy, a pilot study

Background: Hormonal management is first-line therapy for acute abnormal uterine bleeding (AUB) in adolescents. Studies have demonstrated efficacy of oral contraceptive pill (OCP) and progestin tapers and single dose therapy for acute AUB, but comparative studies, side effects and patient satisfaction rates are lacking. Our objective was to implement QI measures to standardize evaluation of acute AUB and prospectively assess time to amenorrhea, patient satisfaction and side effects in teens treated with OCP taper versus single-dose OCP and progestin.

Menstrual suppression in adolescent females with developmental disabilities

Background: Menstrual bleeding in adolescents with developmental delays can be difficult to manage; caregivers have several options for menstrual suppression. The purpose of this study is to prospectively follow indications, clinical characteristics, and outcomes of patients with developmental disabilities receiving menstrual suppression in the pediatric and adolescent population at a tertiary Children's hospital.

Caregiver Knowledge of and Attitudes Toward the Levonorgestrel-Containing Intrauterine Device for the Treatment of Heavy Menstrual Bleeding in Adolescents and Young Adults.

We evaluated caretaker knowledge of and attitudes toward the levonorgestrel-containing intrauterine device (L-IUD) as a treatment option for adolescents and young adults with heavy menstrual bleeding. A survey assessed demographic characteristics, menstrual history, perception of the L-IUD, and knowledge of the indications, risks, and benefits of the L-IUD. Participant recruitment occurred in the offices of a pediatric gynecologist, pediatric hematologist, and adolescent medicine physician in a hospital-based practice in New York. English-speaking caretakers of patients with a chief concern of heavy menstrual bleeding (<21 years old) were invited to participate. Electronic and paper surveys were administered prior to seeing the physician. The primary outcome was participant willingness to allow their daughter to use the L-IUD for heavy menstrual bleeding. Additional outcomes were explored by calculating a mean knowledge score and conducting a descriptive analysis of the perception questions. Forty surveys were included. Seventy percent of participants said they would allow their daughter to use birth control pills for heavy menstrual bleeding, whereas only 10% said the same of the L-IUD. The mean knowledge score was 73.3% (±15.7). Sixty-five percent of participants expressed the need for additional information on the L-IUD. Caretaker acceptance of the L-IUD as treatment for their daughter with heavy menstrual bleeding is limited. Although baseline knowledge was high, many indicated needing additional information. Because heavy menstrual bleeding can negatively impact quality of life, potential caretaker bias must be addressed to ensure full access to this highly effective treatment option.

165 Abnormal uterine bleeding in adolescents as a common medical problem of demographic situation in ukraine

Relevance: Abnormal uterine bleeding is a common medical problem that directly affects the quality of life of girls. In Ukraine, the number of adolescents with abnormal uterine bleeding is growing every year. Aim: The aim is to study the causes, frequency and treatment of AUB and the relationship with somatic and psychological pathology in adolescents. Materials and methods: We analyzed 62 cases of AUB. Patients were adolescents 11-17 years old. They were examined and treated at the clinical bases of Department of Obstetrics, Gynecology and Pediatric Gynecology of Kharkiv National Medical University.

Tamoxifen for the Treatment of Etonogestrel Implant-Associated Bleeding in an Adolescent Gynecology Practice

To describe clinical outcomes in a cohort of adolescent female patients using tamoxifen for the treatment of bothersome etonogestrel (ENG) implant-associated bleeding. Retrospective chart review SETTING: A tertiary children's hospital PARTICIPANTS: Adolescent female patients ages 12-21 seen between August 2016 and August 2019 with an ENG implant in place who received a tamoxifen prescription for the indication of implant-associated bleeding. None MAIN OUTCOME MEASURES: Main outcome measures were implant continuation rates, average time to implant discontinuation after tamoxifen prescription, reasons for implant removal, number of doses and timing of tamoxifen use, bleeding patterns, and adverse effects. A total of 67 patients met the inclusion criteria. The mean age of patients was 16.7 years old. Of the patients with available follow-up data, 49 out of 60 (81.7%) were still using the implant at 12 months, 29 out of 53 (54.7%) at 24 months, and 9 out of 40 (22.5%) at 36 months. The average time from tamoxifen prescription to implant removal was 12.1 months. Bothersome bleeding was the primary reason for ENG implant discontinuation (68.6%). No side effects from tamoxifen use were reported. Tamoxifen was well-tolerated among this cohort of patients and can be considered a treatment option to manage bothersome implant bleeding in adolescents.

A Retrospective Comparison of Time to Cessation of Acute Heavy Menstrual Bleeding in Adolescents Following Two Dose Regimens of Combined Oral Hormonal Therapy

Study ObjectiveAlthough multiple hormonal treatment strategies are effective in decreasing heavy menstrual bleeding (HMB) in adolescents, few studies have compared the relative effectiveness of hormone therapy on the basis of dose. DesignRetrospective chart review SettingUrban tertiary care institution ParticipantsAdolescents aged 9–19 years with acute HMB and anemia in 2008–2018 InterventionsWe used billing codes to identify encounters for acute HMB with hemoglobin less than 12 mg/dl and reviewed initial treatment and time until resolution of acute HMB. We excluded patients who had previously used gonadal steroids or did not complete follow-up. We then compared patients who received combined oral ethinyl estradiol with progestin (EE/P) in standard dosing (EE ≤35 mcg/day) vs taper dosing (EE >35mcg/day in any step-down regimen). Main Outcome MeasuresTime until patient-reported resolution of acute HMB, measured in days from initial treatment ResultsOf 207 patients with vaginal bleeding and anemia, 90 met the criteria for review of therapy type and dose. Users of combined EE/P were hormone-naïve in 28/33 (84.8%) of those who initiated standard EE/P and 22/32 (68.8%) who initiated taper dosing. Bleeding duration was available for 15/28 (53.6%) and 18/22 (81.8%). Resolution of HMB occurred in 0–9 days with standard dosing (mean ±SD 2.1 ± 2.3 days) versus 1–15 days for taper dosing (4.9 ± 4.7; p = 0.04). Excluding six outliers of zero or more than 10 days, HMB ceased by 2.6 and 3 days (n = 12 and 15; p = 0.62). ConclusionCurrently recommended higher dose combined hormonal regimens do not appear to shorten the time to resolution of acute HMB in adolescents.

Research Progress on Treatment of Abnormal Uterine Bleeding during Puberty with Traditional Chinese and Western Medicine

In recent years, the frequency of clinical occurrence of abnormal uterine bleeding in adolescence has gradually increased. In order to fully understand the research progress in the treatment of abnormal uterine bleeding in adolescence, various studies and clinical experience have been reviewed by consulting related literature reports. The results found that currently Western medicine mainly uses hormone drugs in clinical treatment, but there are risks such as more clinical adverse reactions and higher recurrence rate; traditional Chinese medicine (TCM) treatment has achieved satisfactory results, but the advantages of sudden collapse and hemostasis are not obvious. Combined TCM and Western medicine treatment, it can learn from each other and has become a research hotspot in recent years, which is worthy of an in-depth discussion.

70. Improvements in Management of Abnormal Uterine Bleeding in Adolescents after Implementation of a Clinical Decision Guideline within the Emergency Room Setting

<h3>Background</h3> Abnormal uterine bleeding (AUB) is a common gynecologic problem among adolescents, and is broadly described as menstrual bleeding that is abnormal in timing, duration, or quantity. While there are abundant guidelines for assessment and management of this condition in adults, there is no current standard of practice for the adolescent population. This lack of standardized recommendations, combined with provider knowledge gaps, often leads to disorderly workup and management. Dell Children's Medical Center (DCMC) created an AUB clinical guidelines pathway, published in May 2015, for use in the emergency department to standardize clinical decision-making. The utilization rate by emergency department practitioners, as well as the impact of standardizing practice with this pathway, has yet to be studied. <h3>Methods</h3> A 14-question survey was designed to assess if DCMC providers have awareness of the protocol, if they use it to assist with management, and their general knowledge of broad concepts reinforced within the protocol. The survey was emailed to attending physicians, associate providers, fellows, and pediatrics and emergency medicine resident physicians who have worked in the ER at Dell Children's for at least 6 months. <h3>Results</h3> A response rate of 40% was achieved. Half of respondents were residents. 72% reported that they do refer to the above-mentioned protocol for guidance on management and treatment of adolescent patients, and over 90% access the protocol through the DCMC intranet. Of those who don't use the protocol, 30% stated they use their own personal practice guidelines. All answered correctly that "A sterile speculum exam is not indicated for every patient", and 86% appropriately answered "false" to the statement "A pelvic ultrasound is always the first step in work-up for abnormal uterine bleeding in adolescents". However, despite most providers stating that they used the protocol, over half (53%) answered "false" to the statement "All patients presenting with AUB should be screened for a bleeding disorder". Additionally, 22% of respondents answered incorrectly when asked about absolute contraindications to estrogen therapies. <h3>Conclusions</h3> Overall, the response rate and respondent make-up of this survey provided an accurate representation of the providers that work in the DCMC emergency department. While most providers have knowledge of the clinical guidelines protocol and state they use it, the responses reveal significant knowledge gaps in the appropriate diagnosis and management of this condition from both resident and attending providers. Further education of physicians regarding AUB in adolescents, as well as easier access to the protocol may be helpful in improving provider compliance.

13. Contraceptive Implant-associated Abnormal Uterine Bleeding in Adolescents and Young Adults: Predictors, Management, and Rates of Continuation

<h3>Background</h3> Abnormal uterine bleeding (AUB) is commonly experienced by adolescents and young adults (AYA) following contraceptive implant placement. We assessed for predictors of AUB, factors contributing to AUB management, and differences in implant continuation rates by AUB management approach. <h3>Methods</h3> We analyzed data from a long-acting reversible contraception database from 3 AYA sites in tertiary care institutions. We included patients with the contraceptive implant placed from 7/1/2014-12/31/2018 and follow-up data through 12/31/2019. We excluded patients with ≥3 years since insertion without follow-up. Variables included age at insertion, comorbid conditions, menstrual history, prior contraceptive use, patient-reported AUB after implant placement, AUB evaluation and management, and implant discontinuation. We included data from insertion, follow-up, and removal visits. We assessed AUB predictors with logistic regression. Descriptive statistics, chi-square, and t-tests compared patient demographic and clinical variables by AUB status. Survival analysis examined predictors of time to discontinuation. This study was IRB approved. <h3>Results</h3> Our sample included 609 patients, average age was 19 years (SD=2.5). Prior to implant placement 37% reported irregular menses, and after insertion 25% reported AUB. In those with AUB, 67% had evaluation and management including laboratory studies (32%), pelvic ultrasound (4%), or medication therapy (86%). Medication initiation occurred at first AUB report for the majority of patients. Of those prescribed a medication, 60% received a combined oral contraceptive or progestin-only pill. AUB was associated with polycystic ovary syndrome (PCOS) in bivariate analysis (p-value=0.006), 57% of patients with PCOS (n=14) reported AUB after implant insertion. This association persisted after adjusting for age, medical comorbidities, menstrual history, and prior contraceptive use. Bivariate analyses did not identify any predictors for AUB evaluation and management. Implant discontinuation was low: 16% at 1 year, 27% at 2 years, and 35% at 3 years. Early discontinuation was significantly different between patients with and without AUB: 21% vs. 14% at 1 year (p-value=0.047), 38% vs. 23% at 2 years (p-value=0.000), 44% vs. 31% at 3 years (p-value=0.007). Medication for AUB management did not impact rates of or time to early discontinuation. <h3>Conclusions</h3> In this large cohort of AYA, PCOS was the only significant predictor of implant-associated AUB. There were no relationships between AUB and comorbid medical conditions or prior contraceptive use. There were no significant predictors of AUB evaluation and management following implant insertion, and such evaluation and management did not impact rates of early discontinuation.

62. Contraceptive Implant-Associated Abnormal Uterine Bleeding in Adolescents and Young Adults: Predictors, Management, and Rates of Continuation

62. Contraceptive Implant-Associated Abnormal Uterine Bleeding in Adolescents and Young Adults: Predictors, Management, and Rates of Continuation

Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis

To evaluate the ultrasonographic presence of different forms of endometriosis and the associated clinical symptoms in adolescent women. Retrospective observational study. University hospital. Two hundred and seventy women aged 12-20 years referred to the gynecologic ultrasound unit from January 2014 to June2019. Two-dimensional, three-dimensional, and power Doppler ultrasound (US) pelvic examination (transvaginal or transrectal in pre-sexually active adolescents) were performed in all included adolescents. Medical history was collected for each patient before the scan. All possible locations of endometriosis evaluated and recorded using a dedicated ultrasound mapping sheet and severity of painful symptoms evaluated through a visual analogue scale (VAS). Dysmenorrhea was detected in 147 (54.4%) of 270 patients and heavy menstrual bleeding in 76 (28.1%) of 270. At least one ultrasound feature of endometriosis was identified in 36 (13.3%) of 270 cases. Ovarian endometriomas were found in 22 (11%) patients, adenomyosis in 16 (5.2%), and deep infiltrating endometriosis (DIE) in 10 (3.7%). Ultrasound signs of endometriosis were found in 21% of adolescents who reported dysmenorrhea and 33% with dyspareunia. The presence of DIE at ultrasound was associated with bowel symptoms in 33% of patients and associated with dyspareunia in 25% of patients. The detection rate of pelvic endometriotic lesions at ultrasound was 13%. The rates of dysmenorrhea, dyspareunia and heavy menstrual bleeding in adolescents with endometriosis ultrasound signs were statistically significantly higher compared with those without. In patients with dysmenorrhea, the detection rate of pelvic endometriosis at ultrasound increased to 20%. Professionals involved with teens should be aware of the clinical presentation of endometriosis to reduce the delay between the onset of symptoms and the diagnosis, referring these young women to dedicated centers.

Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians regarding abnormal uterine bleeding in adolescents.

The recommendations present the current knowledge and procedures, which can be modified and changed in some cases, after careful analysis of a given clinical situation, which in the future may become the basis for their modification and updating.

The spectrum and severity of bleeding in adolescents with low von Willebrand factor–associated heavy menstrual bleeding

AbstractLow von Willebrand factor (VWF) in adults is associated with significant bleeding, most notably heavy menstrual bleeding (HMB) and postpartum hemorrhage, although this has not been characterized in adolescents. The objectives of this analysis of a multicenter single arm observational cohort study in adolescents with low VWF–associated HMB were to describe the bleeding phenotype, HMB severity, and related complications. Eligibility criteria included postmenarchal females <21 years of age with HMB (Pictorial Blood Assessment Chart [PBAC] score >100) and low VWF (2 values of VWF activity ≥30 and ≤50 IU/dL). Patients diagnosed with other bleeding disorders were ineligible. Clinical phenotype data, including PBAC and Bleeding Assessment Tool (BAT) scores, laboratory data, and HMB management/outcome details, were extracted. Patient demographics and clinical characteristics were summarized as medians with minimum/maximum values or frequencies with percentages. Groups were compared using a Wilcoxon rank-sum test or Fisher's exact test. A total of 113 patients met inclusion criteria, and 2 were excluded. Ninety four percent had a significant bleeding phenotype (BAT score >2), with predominantly mucocutaneous bleeding (32%-44%), postprocedural/surgical bleeding (15%), and severe HMB (BAT HMB domain score ≥2; 90%). Bleeding complications included iron deficiency (60%), anemia (21%), transfusion (12%), and hospitalization (10%). Desmopressin challenge response in subjects tested was good and sustained. Several (48%) required combined therapy for HMB (hormonal/hemostatic), and one third did not show improvement despite therapy. Our results suggest that adolescent females with low VWF have a significant bleeding phenotype and resultant complications warranting a focus on prompt diagnosis, appropriate therapy, and prevention of complications.

24. Tranexamic Acid for Treatment of Acute Heavy Uterine Bleeding in Adolescents Hospitalized with Severe Anemia

24. Tranexamic Acid for Treatment of Acute Heavy Uterine Bleeding in Adolescents Hospitalized with Severe Anemia

Approach to Abnormal Uterine Bleeding in Adolescents

This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. It is hoped that this review will provide readers with an approach to the evaluation and treatment of mild to severe uterine bleeding. AUB is a common problem which has significantly adverse effects on an affected adolescent’s quality of life. The most common underlying condition in AUB in adolescence is anovulation. During the evaluation, pregnancy, trauma and sexually transmitted diseases must be ruled out, regardless of history. It should be kept in mind that AUB during this period may be the first sign of underlying bleeding disorders. Although observation is sufficient in the mild form of AUB, at the other end of the spectrum life-threatening bleeding may necessitate the use of high doses of combined oral contraceptives, intravenous estrogen and/or interventional procedures.

ABNORMAL UTERINE BLEEDING IN ADOLESCENTS: CURRENT STATE OF THE PROBLEM

The aim: To summarize the literature data on abnormal uterine bleeding in adolescents. Materials and methods: This article presents an assessment of 32 literary sources from 2003 to 2018, which raise the issues of etiology and pathogenesis of abnormal uterine bleeding in adolescents. Abnormal uterine bleeding in adolescents (AUBA) is a risk factor for disorders of menstrual and generative function, hormone-related abnormalities in the reproductive age. Despite the progress made in the development of methods for the diagnosis and treatment of AUBA, the criteria for selecting a particular method of diagnosis and therapy have not yet been made sufficiently clear. Conclusions: AUBA is a complex polyetiological disease affecting all parts of the hypothalamic-pituitary-adrenal-ovarian system. It has a negative impact on the girl's health and quality of life. Abnormal uterine bleeding is a "signal" to the body of an organic or functional disorder. If this feature is ignored, the pathology can progress and lead to severe consequences. The urgency of the problem of AUBA is further explained by the fact that this disease indicates the presence of serious disorder of the reproductive system, which in the future may be transformed into impaired reproductive function.

The Use of Norethisterone for the Treatment of Severe Uterine Bleeding in Adolescents: An Audit of Our Experience.

The purpose of this prospective study was to assess the effectiveness of norethisterone (NET) in the management of abnormal uterine bleeding (AUB) in adolescents in a tertiary care center. This was a prospective audit focused on administering high doses of NET in female adolescents with complaints of AUB. We included female adolescents who presented to our Emergency Gynecological Department or Adolescent Gynecological Outpatient Department from October 2016 to January2019. The study included 29 female adolescents aged 11-17 (mean, 13.14) years. Patients were administered a daily dose of 10-30mg, depending on the severity of the condition, bleeding duration, and patient weight. Cessation of vaginal bleeding. Mean age at menarche of our patient sample was 11.4years (range, 10.7-14years). AUB presented at a mean time of 24.6months after menarche (range, 0-79months). Blood transfusion was deemed necessary in 9 patients. Bleeding stopped at a mean of 46.1 (range, 8-120) hours after onset of treatment with NET. No serious adverse events were reported with NET administration, with only 3 cases of minor side effects. The use of NET is an effective and reliable treatment option among adolescents for whom control of AUB is desired in the acute setting.

Is polycystic ovarian syndrome and insulin resistance associated with abnormal uterine bleeding in adolescents?

The aim of the study was to determine if adolescents with juvenile bleeding had polycystic ovarian syndrome (PCOS) and insulin resistance. The study was conducted in a group of 43 females aged 12-18 years, diagnosed with juvenile menorrhagia, and 37 healthy female adolescents aged 12-18 years. The study was conducted during the early follicular phase of the menstrual cycle. Menstrual cycle disturbances, acne and hirsutism were recorded. Ultrasound scan determining the condition of the ovaries was conducted. Laboratory tests of the glucose level, cholesterol, LDL and HDL cholesterol and triglycerides fraction, DHEAS, FSH, LH, insulin, SHGB, total testosterone, androstenedione, and free testosterone have been established. The occurrence of regular menstrual cycles (30.23%, p = 0.006) was significantly lower in the juvenile bleeding group. Also, secondary amenorrhea was significantly more likely to be recognized in this group of females (p = 0.03). The concentration of FSH was considerably lower (p = 0.0002) in the group of adolescents with AUB. Adolescents with abnormal uterine bleeding (AUB) are often diagnosed with secondary amenorrhea, and PCOS. The group with a diagnosis of juvenile bleeding was also diagnosed with higher rates of insulin resistance.