Dysfunctional uterine bleeding in adolescents

Dysfunctional uterine bleeding is a common complaint in adolescent girls. Clinicians working in pediatric, internal medicine, and gynecology offices and in emergency departments are often called upon to make this diagnosis. Dysfunctional bleeding is defined as irregular, painless bleeding of endometrial origin that may be excessive, prolonged, or unpatterned. Although the bleeding is usually secondary to anovulation, the diagnosis is one of exclusion. To make an accurate diagnosis, the clinician must understand the normal adolescent menstrual cycle and related hormone feedback mechanisms. This article reviews the normal hormone mechanisms in the adult and adolescent menstrual cycles in an effort to guide the clinician through the diagnosis. Potential causes and recommended treatment modalities are reviewed.