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Adolescent Women
DISCLOSURE
I have no financial
relationships with any
commercial interests
related to the content of
this activity today.
Objectives
Discuss:
Terminology
Menorrhagia (Hypermenorrhea)
Metrorrhagia
1.
2.
Population Statistics
Population
21-67%
Overview of Etiology
Healthy Adolescents
Anovulation
Endocinopathy
Bleeding disorder
Malignancy/Chemotherapy
Medication effects
Solid organ transplant
Stem cell transplant
Adolescent Menses
Rarely
Menstrual Parameters
body survey!
3.
4.
TSH
Platelet
function
screen
Prolactin
CBC
Management:
Menorrhagia without
Anemia
Most common etiology = anovulation
Order laboratory tests based on medical history
Management Strategies
Immediate: Menstrual Regulation (3-6 mos)
1.
Monthly Progesterone
Micronized P 400 mg qhs x 10 days
Medroxyprogesterone acetate 20 mg/d x 10 days
2.
3.
NSAIDS
Anovulatory
cycles
Hypothalmic
disorders
Athletic
activities
All of the
above
Management Strategies
Long term:
Menstrual Calendar:
Consider other medical needs:
Contraception
Acne/Hirsutism
Medical Evaluation:
Menorrhagia + Anemia
Evaluation for Bleeding Disorders:
Management Strategies:
Menorrhagia + Anemia
Immediate: Control Bleeding
Pills
Vaginal ring
Patch
2.
Combined E + P Pill taper:
4 pills / d x 4d
3 pills / d x 3d
2 pills / d x 2d
One pill / d x 30 d
Withdrawal bleed
(May combine routes of administration )
3.
Adjuvant Therapy
Antiemetics
NSAIDS
Tranexamic acid
Management Strategies:
Menorrhagia + Anemia
Long Term Management
1.
Based on diagnosis
2.
Evaluation of acute
Menorrhagia/Hemorrhage
1.
2.
3.
4.
5.
3.
2.
3.
4.
Intravenous
conjugated
estrogen
Combined
hormonal
contraceptive
regimens
Both
Neither
4.
5.
6.
If E contraindicated:
Alternative progestin's
6.
Adjuvant Therapies
a.
b.
c.
2.
Noncyclic
P- only OCP
Etonogestrel Implant
3.
Levonorgestral IUS
Evidence of good success in patients with a variety of
bleeding disorders
Insert after acute bleeding controlled
Ref:
4.
Adjunctive Medications
a.
b.
c.
2.
3.
4.
Continuous
combined
estrogen and
progesterone oral
contraceptives
Levonorgestral
IUD
Depo
medroxyprogeste
rone acetate
All of the above