Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.21.6 (thromboplastin)
 13,278 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reviews the physiology of menstrual abnormalities in the adolescent and suggests a management protocol based on this pathophysiological framework. Initial discussion covers the physiology of puberty and menstruation. Menstrual abnormalities occur often in the adolescent. Excessive bleeding is the most dramatic symptom, but the most common complaints concern the frequency, duration, and variability of menstrual flow. Often the oral contraceptive (OC) pill is the panacea for the patient, her family, and the physician. This solution has several advantages. It is attractive, inexpensive, easy to use, and regulates the menstrual cycle. Although menstrual abnormalities are seemingly corrected, the treatment is not physiological. This use of the OC pill may mask the underlying problem and delay the diagnosis of a medical disorder and will interfere with the normal maturation of the hypothalamic-pituitary-ovarian axis, which is necessary for regular menses to occur. The diagnosis of anovulatory bleeding is one of exclusion. Both local and systemic problems can mimic dysfunctional bleeding. Pregnancy must always be considered but is often overlooked in the young teenager. A satisfactory history and physical examination, including a vaginal and/or rectal examination, is paramount to rule out other causes. Coagulation defects may play a significant role in adolescent bleeding abnormalities. Endocrine disorders, including thyroid disease, Cushing's syndrome, hypoprolactinemia, and acromegaly, can result in menstrual abnormalities. After a meticulous history and physical examination, any teenager presenting with abnormal vaginal bleeding should not exhibit any physical abnormality other than the signs and symptoms of blood loss. The initial laboratory tests need not be extensive but must include a hemoglobin estimation, blood smear, platelet count, bleeding time, prothrombin time, partial thromboplastin time, and thyroid function tests. Only the simplest classification based on the hemoglobin concentration is needed for effective clinical management. Those that have hemoglobins greater than 20 grams per liter are considered to have a mild disturbance, those between 100-120 grams per liter have a moderate abnormality, and those with a hemoglobin less than 100 grams per liter are considered to have a severe problem. Therapy should be individualized and based on physiological principles.
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PMID:Menstrual abnormalities in the adolescent abuse of the birth control pill. 1231 70