[Dysfunctional uterine bleeding in the adolescent].

Dysfunctional uterine bleeding is a frequent gynecological problem in adolescent girls. Seventy five percent of cases of abnormal uterine bleeding in teenagers are of a functional nature and are frequently related to inappropriate peripheral and central feedback mechanisms involved in the regulation of the ovulation process. A precise diagnosis is mandatory in order to exclude systemic and local causes of abnormal uterine bleeding. Acute and profuse dysfunctional uterine bleeding requires emergency treatment including hormonal hemostasis (intravenous estrogens and an oral estrogen-progestin combination pill in high dosage) as the first step. If bleeding persists and blood coagulation is normal, careful examination under anesthesia followed by gentle dilatation and curettage of the uterus is performed. Cyclic regulation of the menstrual cycle is then achieved by prescribing an estrogen-progestin pill for the next three months. In 5% of the patients, dysfunctional bleeding will persist, often denoting a chronic anovulatory pattern of the cycle. In these cases, long term administration of a progestin in the second part of the cycle is indicated in order to avoid prolonged exposure to unopposed estrogens.