Research Article
"Ağır anovulatuar uterin kanama’" tanısıyla izlenen kız ergenlerin değerlendirilmesi: pediatrist gözüyle ‘aşırı menstrual kanamalar’
Abstract
Amaç: Ergenlerde aşırı menstrual kanamaların sıklıkla nedeni “Hipotalamo-hipofizer-over aks” immatürasyonuna bağlı anovultuar sikluslardır. Yazımızda, ‘Ağır Anovulatuar uterin kanama (AnUK)’ tanısı ile izlenen kız ergenlerin değerlendirilmesi amaçlanmıştır.
Gereç ve yöntemler: Hastanemiz Adolesan/Ergen polikliniğine ’Eylül 2018- Ağustos 2019’ tarihleri arasında başvuran, kronik hastalığı olmayan, aktif uterin kanama ya da dış merkezde demir eksikliği anemisi tanısı alıp öyküde uzamış, fazla miktarda menstrual kanama tarif eden hastalar dahil edildi. Dışlama tetkikleri sonrası ‘Ağır AnUK’ tanısı alan hastalar geriye dönük değerlendirildi.
Bulgular: Toplam 15 kız ergenin; yaş ortalaması 15.06±1.65, menarş yaşı ort. 12.2±1 yıldı. Yapısal nedenler için yapılan suprapubik ultrason görüntüleme tüm hastalarda normaldi. Koagulopati, endokrinopati hastalıklarına yönelik laboratuar tetkikleri normaldi. Geliş hemoglobin (Hb) ort. 8.04 ±1.38 gr/dL, ferritin 2.12±0.78 ng/ml’ydi. Hospitalize edilen 5 hastanın 3’üne hemodinamik dekompanzasyon nedeniyle eritrosit transfüzyonu verildi. Olgulara 3 siklus monofazik kombine oral kontraseptif ve demir+2 tedavi dozunda başlandı. Tedavi sonrası birinci ve üçüncü ay Hb değerlerinde artış istatistiksel anlamlıydı. Tedavi sonrası izlemde menstrual siklus düzenleri normaldi.
Sonuç: Kız ergen yaş grubunda aşırı menstrual kanamaların en önemli morbiditesi ağır demir aksikliği anemisidir. Tedavide, monofazik kombine oral kontraseptifler ile demir tedavisi etkili bir tedavi seçeneğidir.
Keywords
References
- 1. Moon LM, Perez-Milicua G, Dietrich JE. Evaluation and management of heavy menstrual bleeding in adolescents. Curr Opin Obstet Gynecol, 2017. 29(5): p. 328-336.
- 2. Bennett AR, Gray SH. What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents. Curr Opin Pediatr, 2014. 26(4): p. 413-9.
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- 7. Elmaogullari S, Aycan Z. Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol, 2018. 10(3): p. 191-197.
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- 17. Mullins TL, Miller RJ, Mullins ES. Evaluation and Management of Adolescents with Abnormal Uterine Bleeding. Pediatr Ann, 2015. 44(9): p. e218-22.
- 18. Alaqzam TS, Stanley AC, Simpson PM, Flood VH, Menon S.Treatment Modalities in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol, 2018. 31(5): p. 451-458.
- 19. Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev, 2019. 2: p. CD000154.
- 20. O'Brien B, Mason J, Kimble R. Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding: The Queensland Statewide Paediatric and Adolescent Gynaecology Service. J Pediatr Adolesc Gynecol, 2019. 32(2): p. 122-127.
- 21. Ahuja SP, Hertweck SP. Overview of bleeding disorders in adolescent females with menorrhagia. J Pediatr Adolesc Gynecol, 2010. 23(6 Suppl): p. S15-21.
- 22. Dragoman MV, Tepper NK, Fu R, Curtis KM, Chou R, Gaffield ME. A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception. Int J Gynaecol Obstet, 2018. 141(3): p. 287-294.
- 23. Powell A. Choosing the Right Oral Contraceptive Pill for Teens. Pediatr Clin North Am, 2017. 64(2): p. 343-358.
Year 2020,
Volume: 17 Issue: 3, 420 - 424, 30.09.2020
Abstract
References
- 1. Moon LM, Perez-Milicua G, Dietrich JE. Evaluation and management of heavy menstrual bleeding in adolescents. Curr Opin Obstet Gynecol, 2017. 29(5): p. 328-336.
- 2. Bennett AR, Gray SH. What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents. Curr Opin Pediatr, 2014. 26(4): p. 413-9.
- 3. ACOG Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstet Gynecol, 2015. 126(6): p. e143-6.
- 4. Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics, 2006. 118(5): p. 2245-50.
- 5. Esen I, Oguz B, Serin HM. Menstrual Characteristics of Pubertal Girls: A Questionnaire-Based Study in Turkey. J Clin Res Pediatr Endocrinol, 2016. 8(2): p. 192-6.
- 6. Friberg B, Ornö AK, Lindgren A, Lethagen S. Bleeding disorders among young women: a population-based prevalence study. Acta Obstet Gynecol Scand, 2006. 85(2): p. 200-6.
- 7. Elmaogullari S, Aycan Z. Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol, 2018. 10(3): p. 191-197.
- 8. Zia A, Rajpurkar M. Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thromb Res, 2016. 143: p. 91-100.
- 9. Haamid F, Sass AE, Dietrich JE. Heavy Menstrual Bleeding in Adolescents. J Pediatr Adolesc Gynecol, 2017. 30(3): p. 335-340.
- 10. Cooke AG, McCavit TL, Buchanan GR, Powers JM. Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol, 2017. 30(2): p. 247-250.
- 11. Adams Hillard PJ. Menstruation in adolescents: what do we know? And what do we do with the information? J Pediatr Adolesc Gynecol, 2014. 27(6): p. 309-19.
- 12. Powers JM, Stanek JR, Srivaths L, Haamid FW, O'Brien SH. Hematologic Considerations and Management of Adolescent Girls with Heavy Menstrual Bleeding and Anemia in US Children's Hospitals. J Pediatr Adolesc Gynecol, 2018. 31(5): p. 446-450.
- 13. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet, 2016. 387(10021): p. 907-16.
- 14. Benjamins LJ. Practice guideline: evaluation and management of abnormal vaginal bleeding in adolescents. J Pediatr Health Care, 2009. 23(3): p. 189-193.
- 15. Metcalf MG, Skidmore DS, Lowry GF, Mackenzie JA. Incidence of ovulation in the years after the menarche. J Endocrinol, 1983. 97(2): p. 213-9.
- 16. Apter D, Vihko R. Early menarche, a risk factor for breast cancer, indicates early onset of ovulatory cycles. J Clin Endocrinol Metab, 1983. 57(1): p. 82-6.
- 17. Mullins TL, Miller RJ, Mullins ES. Evaluation and Management of Adolescents with Abnormal Uterine Bleeding. Pediatr Ann, 2015. 44(9): p. e218-22.
- 18. Alaqzam TS, Stanley AC, Simpson PM, Flood VH, Menon S.Treatment Modalities in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol, 2018. 31(5): p. 451-458.
- 19. Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev, 2019. 2: p. CD000154.
- 20. O'Brien B, Mason J, Kimble R. Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding: The Queensland Statewide Paediatric and Adolescent Gynaecology Service. J Pediatr Adolesc Gynecol, 2019. 32(2): p. 122-127.
- 21. Ahuja SP, Hertweck SP. Overview of bleeding disorders in adolescent females with menorrhagia. J Pediatr Adolesc Gynecol, 2010. 23(6 Suppl): p. S15-21.
- 22. Dragoman MV, Tepper NK, Fu R, Curtis KM, Chou R, Gaffield ME. A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception. Int J Gynaecol Obstet, 2018. 141(3): p. 287-294.
- 23. Powell A. Choosing the Right Oral Contraceptive Pill for Teens. Pediatr Clin North Am, 2017. 64(2): p. 343-358.
There are 23 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Paediatrics, Obstetrics and Gynaecology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 30, 2020 |
| Submission Date | February 25, 2020 |
| Acceptance Date | May 26, 2020 |
| Published in Issue | Year 2020 Volume: 17 Issue: 3 |
