Manejo do sangramento uterino disfuncional em adolescentes

Management of dysfunctional uterine bleeding in adolescents

Abstract

Menstrual disorders and abnormal uterine bleeding (AUB) are among the most frequent gynecologic complaints of adolescents. Abnormal uterine bleeding (AUB) refers to bleeding that is excessive or occurs outside of normal cyclic menstruation. AUB is described by a variety of terms and may be caused by a number of genital and nongenital tract diseases, systemic disorders, and medications Common causes of AUB in pubertal adolescents include anovulation, bleeding diathesis, stress, pregnancy, and infection. Additional causes  which are more common among gynecologically mature adolescents, include endocrine dysfunction (PCOS, hypothyroidism), changes due to effects of hormonal contraception, structural lesions (eg, polyps, fibroids), and cancer. Dysfunctional uterine bleeding is defined as abnormal uterine bleeding (AUB) without an identifiable pathologic condition.
The initial evaluation of all adolescents with AUB should include exclusion of pregnancy (especially ectopic pregnancy), assessment of
hemodynamic status (blood pressure, heart rate), and hemoglobin or hematocrit and platelet count to evaluate the presence of anemia or thrombocytopenia. The additional evaluation depends upon findings from the history and physical examination
The treatment for these disorders ranges from observation to pharmacologic and/or surgical therapy. The discussion below primarily pertains to AUB in otherwise healthy adolescents. Potential sequelae of AUB include anemia and endometrial cancer. With appropriate management of the underlying problem, these sequelae may be prevented. Thus, it is crucial to establish the correct diagnosis before any therapy is administered.