PCOS Common Reason for Severe Abnormal Uterine Bleeding in Adolescents
By Rita Buckley; December 23, 2016
Polycystic Ovary Syndrome is a common cause of severe abnormal uterine bleeding in adolescent females and warrants early screening for signs of hyperandrogenemia. Sofia Malyanskaya of Albert Einstein College in the Bronx emphasizes that PCOS is the most common endocrine disorder seen in women and is associated with increased risk of other serious illnesses like cardiovascular disease, endometrial cancer and diabetes mellitus. It is usually under-recognized in young adults. This leads to an increased amount of preventable lifetime risk of aforementioned serious illnesses.
Dr. Malyanskaya and colleagues designed a retrospective study in 125 females (ages 8-20) who were admitted to Montefiore Children’s hospital with acute menorrhagia and anemia between 2000-2014. Overall, the mean hemoglobin level was 7 mg/dl and mean age was 16.5. Of the participants ovulatory dysfunction related to PCOS accounted for 33% of the admissions, and was deemed the most common underlying cause of abnormal uterine bleeding. Ovulatory dysfunction due to immature hypothalamic-pituitary-ovarian axis constituted 31%, endometriosis for 13% and bleeding disorders for 10%.
Dr. Malyanskaya advised that adolescent girls who present with abnormal uterine bleeds and anemia should first be screened for PCOS before beginning treatment with hormones or transfusions. Dr Jennifer Leigh Rosenblum of Massachusetts General Hospital, Boston, agreed commenting that concurrent treatment with oral contraceptive pills may make a diagnosis of PCOS more difficult. Dr Stacey Leigh Rubin of Johns Hopkins Medicine, Baltimore, noted that the findings may only apply to a small population due to selection of patients with anemia severe enough to warrant hospitalization, which is rare when attributed to abnormal uterine bleeding. The demographics are also cause for concern Dr Rubin remarks, because the Bronx population over represents Asian and Latina adolescents compared to the rest of the US.
J Pediatr Adolesc Gynecol 2016.