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Query: UMLS:C0745411 (irregular bleeding)
 386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This discussion of vaginal bleeding in adolescents reviews the causes of dysfunctional uterine bleeding (complications of pregnancy, pelvic inflammatory disease and/or complications of the use of oral contraceptives or IUDs, blood dyscrasias, trauma and foreign bodies, tumors, and other causes) as well as the diagnosis and treatment of dysfunctional uterine bleeding. Menstrual irregularities are the most common cause of abnormal vaginal bleeding in adolescence and can be managed easily in the office. On occasion an adolescent needs to be hospitalized for acute menorrhagia; very rarely a surgical procedure such as dilatation and curettage is necessary. Dysfunctional uterine bleeding is defined as abnormal uterine bleeding without local anatomic causes. It is a diagnosis of exclusion and requires an adequate examination of the vagina, cervix, and other pelvic organs. Some local bleeding presents as irregular vaginal bleeding in adolescents and is diagnosed as dysfunctional bleeding. The diagnosis of pregnancy and related complications (threatened abortion, incomplete or complete abortion, ectopic pregnancy, and postabortal trophoblastic disease) may present as irregular bleeding in the practitioner's office. A teenager may give a history of pregnancy if she is questioned about it closely and confidentially. A high index of suspicion will help the clinician to make this diagnosis. Salpingitis should be suspected in any teenager who presents with low abdominal tenderness, pain, abnormal bleeding, low grade fever, and tenderness on cervical movement. Approximately 10% of teenagers with blood dyscrasias present with cyclic hypermenorrhea. Vaginal ulcerations and objects introduced into the vagina occasionally cause irregular bleeding. Such tumors as clear cell adenocarcinoma of the vaginal and sarcoma botyroides may present as metrorrhagia. These etiologic factors comprise as most only about 5% of adolescents who complain of irregular vaginal bleeding. The most common cause of such bleeding is anovulation or oligoovulation due to the noncyclic release of follicle stimulating hormone (FSH) and luteinizing hormone (LH) during adolescence. Although the most common cause of this cyclic disturbance is the hypothalamic pituitary ovarian axis, some well known endocrine disorders can also produce this picture. 95-97% of adolescents will have no organic reason for their irregular bleeding. The diagnosis of dysfunctional uterine bleeding is then made. Detailed suggestions are provided on how to proceed which will prevent grave errors in the diagnosis and treatment of dysfunctional uterine bleeding in adolescents. The patient who has been bleeding very heavily and has a hematocrit less than 30 may have to be hospitalized. A medical D and C can be done with a progestational agent. Such patients may need a transfusion of packed cells and should be kept on oral iron. They also need cycling with Ovral for 2-3 months and must be followed carefully.
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PMID:Vaginal bleeding in adolescents. 674 72

Chlamydia trachomatis was found to be the aetiological agent of endometritis in three women with concomitant signs of salpingitis. All patients developed a significant antibody response to the organism. Chlamydia were recovered from aspirated uterine contents of two patients and darkfield examination of histological sections showed chlamydial inclusions in endometrial cells in one patient. Thus, C trachomatis can be recovered from the endometrium of patients in whom the cervical culture result is negative. In one patient curettage showed endometritis with a characteristic plasma-cell infiltration. The occurrence of chlamydial endometritis may explain why irregular bleeding is a common finding in patients with salpingitis. It also suggests a canalicular spread of chlamydia from the cervix to the Fallopian tubes.
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PMID:Endometritis caused by Chlamydia trachomatis. 723 83

Chlamydia trachomatis was recovered from the fallopian tubes of ten women with acute salpingitis. The median age of the patients was 19 years. The duration of pelvic pain before consulting a physician ranged from three to 27 days (median, seven days). Half of the patients complained of irregular bleeding, and nine reported increased vaginal discharge. One patient had a rectal temperature of greater than 38 C, and one had an erythrocyte sedimentation rate of less than 15 mm/hr. At laparoscopy, mild inflammatory changes were seen in the tubes of three patients, five had moderately severe inflammation, and two had pelvic peritonitis. C. trachomatis could not be isolated from the cervix of two patients. Paired sera were available from eight patients, six of whom had a significant rise in titer of IgG antibodies to C. trachomatis. Two women had IgM antibodies. Two other women, who harbored Neisseria gonorrhoeae in the cervix, had antibodies to gonococcal pili; one had a significant decrease in titer. This latter patient was one of the patients with a stationary titer of antibodies to C trachomatis. One patient had a stationary titer of antibodies to Mycoplasma hominis. In general, chlamydial salpingitis seems to have relatively benign symptoms. Neither the failure to isolate C. trachomatis from the cervix nor a stationary titer of antibodies to the organism precludes a chlamydial etiology of acute salpingitis.
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PMID:Acute salpingitis with Chlamydia trachomatis isolated from the fallopian tubes: clinical, cultural, and serologic findings. 725 92