The Utility of Routine Ultrasound in the Diagnosis and Management of Adolescents with Abnormal Uterine Bleeding

Yael Pecchioli, Lamide Oyewumi, Lisa Allen, Sari Kives
In: Journal of Pediatric and Adolescent Gynecology · 2016 · vol. 30(2) , pp. 239–242 · doi:10.1016/j.jpag.2016.09.012 · PMID:27721027 · W1979118148
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This study evaluated the effectiveness of routine ultrasound in diagnosing and managing abnormal uterine bleeding in adolescents.

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Abstract

Study objectiveDespite the fact that most cases of abnormal uterine bleeding (AUB) in adolescence are due to an immature hypothalamic-pituitary-ovarian (HPO) axis, the current approach to investigating adolescents who present with AUB often includes pelvic ultrasound to exclude rare structural causes. The aim of this study was to determine whether an ultrasound ordered for the investigation of AUB in adolescents detects any significant anatomic pathology or alters diagnosis and management.Design, setting, participants, and interventionsA retrospective chart review of 230 patients younger than 18 years of age who presented with AUB to the gynecology clinic at the Hospital for Sick Children in Toronto, Canada between January 2010 and December 2012 was completed.Main outcome measuresFindings on pelvic ultrasound and any further imaging as well as management choices for these patients were examined.ResultsOf all patients, 67.8% (156/230) had ultrasound done as part of their AUB workup. The most common diagnosis for the patients who received ultrasound examinations and the patients who did not was AUB due to an immature HPO axis. Of the patients who received an ultrasound examination, 72.4% (113/156) had normal findings; incidental findings were identified in 17.9% (28/156) and polycystic ovary syndrome morphology in 6.4% (10/156). Structural causes of AUB were found in only 2 (1.3%) of the adolescents imaged. No patient had a change in her AUB management plan because of ultrasound findings.ConclusionOur results strongly suggest that pelvic ultrasound examination is not required in the initial investigation of AUB in the adolescent population because it did not alter treatment in any of our patients.

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