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Abnormal Vaginal Bleeding During the Early Reproductive Years

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Handbook of Gynecology

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Abstract

Abnormal uterine bleeding (AUB) is defined as bleeding from the uterine corpus that is abnormal in duration, volume, frequency, and/or volume. It is particularly common in young reproductive-age women from menarche to age 25. Up to one in five adolescents has AUB. Heavy menstrual bleeding (HMB) is the most frequent type of AUB; population studies show that 12–57% of healthy adolescents report HMB (Hernandez et al., Obstet Gynecol 135(3):615–621, 2020). However, other abnormalities can present during those years, including absence of bleeding (primary or secondary amenorrhea), infrequent bleeding, intermenstrual bleeding, and postcoital bleeding. The major causes of menstrual problems vary with age. While pregnancy, trauma, and infection must always be excluded, outlet obstruction and bleeding disorders are more likely to be diagnosed early in reproductive life; malignancies are more likely to be found in older patients.

Puberty complicates the recognition of abnormal uterine bleeding as there is a variable time period when irregular bleeding is expected. The average age of menarche for girls in developed countries has been 12–13 years but there is considerable interindividual variation. Time to establish normal monthly cycling consistent with ovulation and maturation of the hypothalamic-pituitary-ovarian axis varies from 6 months to 3 years following menarche. But even within this variability, there are parameters that can help identify outliers who would benefit from earlier evaluation. Heavy menstrual bleeding and prolonged bleeding can result in the extreme life-threatening anemia or can have devastating impacts on the young person’s quality of life. HMB can present as an acute medical emergency or as a chronic problem. In addition to bleeding issues, menses can be associated with other physical complaints and exacerbation of other medical problems. While all adolescent and young adult (AYA) women with AUB deserve full evaluation and individualized therapies, those in special populations may present more clinical challenges and have different therapeutic goals.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Western University of Health Sciences, Pomona, CA, USA

    Anita L. Nelson

  2. Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Anita L. Nelson

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  1. Anita L. Nelson
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Correspondence to Anita L. Nelson .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology and Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Donna Shoupe

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Nelson, A.L. (2023). Abnormal Vaginal Bleeding During the Early Reproductive Years. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_23-2

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  • DOI: https://doi.org/10.1007/978-3-319-17002-2_23-2

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