Abnormal vaginal bleeding in adolescents

Abnormal menses include those that last for longer than 7 days, occur more frequently than every 21 days (from the first day of one period to the first day of the next period) or less frequently than every 35 days, and those that result in iron deficiency anemia. DUB is the most common cause of frequent or prolonged menses in young adolescents, but this is a diagnosis of exclusion; the clinician must perform a history, physical examination, and laboratory tests to exclude other medical causes. Patient reports of menstrual blood loss can be unreliable; objective data such as hemoglobin concentrations and reticulocyte count should be obtained to monitor symptoms. Because complications of pregnancy may present with any bleeding pattern, pregnancy should be excluded in all those who have unexplained bleeding, even those who deny sexual activity. Most abnormal bleeding can be managed medically. Evidence is insufficient to support any particular hormone regimen over another for treatment, although randomized, controlled trials have shown that COCs decrease the amount of blood loss during menses.