Polycystic Ovary Syndrome

An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital

Sofya Maslyanskaya, Hina J. Talib, Jennifer L. Northridge, Amanda M. Jacobs, Chanelle Coble, Susan M. Coupey

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Study Objective: To evaluate whether ovulatory dysfunction due to polycystic ovary syndrome (PCOS) is a common underlying etiology of abnormal uterine bleeding (AUB) in adolescents who require hospitalization and to explore etiology, treatment, and complications of AUB with severe anemia in adolescents. Design, Setting, Participants, Interventions, and Main Outcome Measures: We identified female patients aged 8-20 years admitted to a children's hospital for treatment of AUB from January 2000 to December 2014. Our hospital protocol advises hormonal testing for PCOS and other disorders before treatment for AUB. We reviewed medical records and recorded laboratory evaluations, treatments, and final underlying diagnoses as well as recurrences of AUB and readmissions in the subsequent year. Results: Of the 125 subjects, the mean age was 16.5 ± 2.9 years; mean hemoglobin level was 7.0 ± 1.8 g/dL; 54% were overweight/obese; and 41% sexually active. PCOS accounted for 33% of admissions; hypothalamic pituitary ovarian axis immaturity 31%; endometritis 13%; bleeding disorders 10%. Girls with PCOS were more likely to be overweight/obese (74% vs 46%; P < .01) and girls with hypothalamic pituitary ovarian axis immaturity had lower hemoglobin levels (6.4 g/dL vs 7.4 g/dL; P < .05), than girls with all other etiologies of AUB. Treating physicians failed to diagnose endometritis as the etiology for AUB in 4 of 8 girls with positive tests for sexually transmitted infection and no other etiology. Conclusion: PCOS was the most common underlying etiology in adolescents hospitalized with AUB. Screening for hyperandrogenemia is important for early diagnosis of PCOS to allow ongoing management and prevention of comorbidities. Endometritis was frequently underestimated as an etiology for AUB.

Original languageEnglish (US)
JournalJournal of Pediatric and Adolescent Gynecology
DOIs
StateAccepted/In press - 2016

Fingerprint

Uterine Hemorrhage
Polycystic Ovary Syndrome
Endometritis
Hemoglobins
Hospitalized Adolescent
Therapeutics
Sexually Transmitted Diseases
Medical Records
Comorbidity
Anemia
Early Diagnosis
Hospitalization
Outcome Assessment (Health Care)
Hemorrhage
Physicians
Recurrence

Keywords

  • Abnormal uterine bleeding
  • Adolescent
  • Anemia
  • Endometritis
  • Menorrhagia
  • Polycystic Ovary Syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

@article{f67788cc222c432cbac69a609222b96f,
title = "Polycystic Ovary Syndrome: An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital",
abstract = "Study Objective: To evaluate whether ovulatory dysfunction due to polycystic ovary syndrome (PCOS) is a common underlying etiology of abnormal uterine bleeding (AUB) in adolescents who require hospitalization and to explore etiology, treatment, and complications of AUB with severe anemia in adolescents. Design, Setting, Participants, Interventions, and Main Outcome Measures: We identified female patients aged 8-20 years admitted to a children's hospital for treatment of AUB from January 2000 to December 2014. Our hospital protocol advises hormonal testing for PCOS and other disorders before treatment for AUB. We reviewed medical records and recorded laboratory evaluations, treatments, and final underlying diagnoses as well as recurrences of AUB and readmissions in the subsequent year. Results: Of the 125 subjects, the mean age was 16.5 ± 2.9 years; mean hemoglobin level was 7.0 ± 1.8 g/dL; 54{\%} were overweight/obese; and 41{\%} sexually active. PCOS accounted for 33{\%} of admissions; hypothalamic pituitary ovarian axis immaturity 31{\%}; endometritis 13{\%}; bleeding disorders 10{\%}. Girls with PCOS were more likely to be overweight/obese (74{\%} vs 46{\%}; P < .01) and girls with hypothalamic pituitary ovarian axis immaturity had lower hemoglobin levels (6.4 g/dL vs 7.4 g/dL; P < .05), than girls with all other etiologies of AUB. Treating physicians failed to diagnose endometritis as the etiology for AUB in 4 of 8 girls with positive tests for sexually transmitted infection and no other etiology. Conclusion: PCOS was the most common underlying etiology in adolescents hospitalized with AUB. Screening for hyperandrogenemia is important for early diagnosis of PCOS to allow ongoing management and prevention of comorbidities. Endometritis was frequently underestimated as an etiology for AUB.",
keywords = "Abnormal uterine bleeding, Adolescent, Anemia, Endometritis, Menorrhagia, Polycystic Ovary Syndrome",
author = "Sofya Maslyanskaya and Talib, {Hina J.} and Northridge, {Jennifer L.} and Jacobs, {Amanda M.} and Chanelle Coble and Coupey, {Susan M.}",
year = "2016",
doi = "10.1016/j.jpag.2016.11.009",
language = "English (US)",
journal = "Journal of Pediatric and Adolescent Gynecology",
issn = "1083-3188",
publisher = "Elsevier USA",

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T2 - An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital

AU - Maslyanskaya, Sofya

AU - Talib, Hina J.

AU - Northridge, Jennifer L.

AU - Jacobs, Amanda M.

AU - Coble, Chanelle

AU - Coupey, Susan M.

PY - 2016

Y1 - 2016

N2 - Study Objective: To evaluate whether ovulatory dysfunction due to polycystic ovary syndrome (PCOS) is a common underlying etiology of abnormal uterine bleeding (AUB) in adolescents who require hospitalization and to explore etiology, treatment, and complications of AUB with severe anemia in adolescents. Design, Setting, Participants, Interventions, and Main Outcome Measures: We identified female patients aged 8-20 years admitted to a children's hospital for treatment of AUB from January 2000 to December 2014. Our hospital protocol advises hormonal testing for PCOS and other disorders before treatment for AUB. We reviewed medical records and recorded laboratory evaluations, treatments, and final underlying diagnoses as well as recurrences of AUB and readmissions in the subsequent year. Results: Of the 125 subjects, the mean age was 16.5 ± 2.9 years; mean hemoglobin level was 7.0 ± 1.8 g/dL; 54% were overweight/obese; and 41% sexually active. PCOS accounted for 33% of admissions; hypothalamic pituitary ovarian axis immaturity 31%; endometritis 13%; bleeding disorders 10%. Girls with PCOS were more likely to be overweight/obese (74% vs 46%; P < .01) and girls with hypothalamic pituitary ovarian axis immaturity had lower hemoglobin levels (6.4 g/dL vs 7.4 g/dL; P < .05), than girls with all other etiologies of AUB. Treating physicians failed to diagnose endometritis as the etiology for AUB in 4 of 8 girls with positive tests for sexually transmitted infection and no other etiology. Conclusion: PCOS was the most common underlying etiology in adolescents hospitalized with AUB. Screening for hyperandrogenemia is important for early diagnosis of PCOS to allow ongoing management and prevention of comorbidities. Endometritis was frequently underestimated as an etiology for AUB.

AB - Study Objective: To evaluate whether ovulatory dysfunction due to polycystic ovary syndrome (PCOS) is a common underlying etiology of abnormal uterine bleeding (AUB) in adolescents who require hospitalization and to explore etiology, treatment, and complications of AUB with severe anemia in adolescents. Design, Setting, Participants, Interventions, and Main Outcome Measures: We identified female patients aged 8-20 years admitted to a children's hospital for treatment of AUB from January 2000 to December 2014. Our hospital protocol advises hormonal testing for PCOS and other disorders before treatment for AUB. We reviewed medical records and recorded laboratory evaluations, treatments, and final underlying diagnoses as well as recurrences of AUB and readmissions in the subsequent year. Results: Of the 125 subjects, the mean age was 16.5 ± 2.9 years; mean hemoglobin level was 7.0 ± 1.8 g/dL; 54% were overweight/obese; and 41% sexually active. PCOS accounted for 33% of admissions; hypothalamic pituitary ovarian axis immaturity 31%; endometritis 13%; bleeding disorders 10%. Girls with PCOS were more likely to be overweight/obese (74% vs 46%; P < .01) and girls with hypothalamic pituitary ovarian axis immaturity had lower hemoglobin levels (6.4 g/dL vs 7.4 g/dL; P < .05), than girls with all other etiologies of AUB. Treating physicians failed to diagnose endometritis as the etiology for AUB in 4 of 8 girls with positive tests for sexually transmitted infection and no other etiology. Conclusion: PCOS was the most common underlying etiology in adolescents hospitalized with AUB. Screening for hyperandrogenemia is important for early diagnosis of PCOS to allow ongoing management and prevention of comorbidities. Endometritis was frequently underestimated as an etiology for AUB.

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KW - Adolescent

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KW - Menorrhagia

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