title: Treatment of Acute Abnormal Uterine Bleeding in Adolescents: What Are Providers Doing in Various Specialties?
abstract: OBJECTIVE
  The purpose of this study was to assess whether variability exists in the management of acute abnormal uterine bleeding (AUB) in adolescents between pediatric Emergency Department (ED) physicians, pediatric gynecologists, and adolescent medicine specialists.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary care medical center ED.
  
  
  METHODS
  We included girls aged 9-22 years who presented from July 2008 to June 2014 with the complaint of acute AUB. Patients were identified using the International Classification of Diseases, ninth revision codes for heavy menstrual bleeding, AUB, and irregular menses. Exclusion criteria included pregnancy and current use of hormonal therapy. One hundred fifty patients were included.
  
  
  RESULTS
  Among those evaluated, 61% (n = 92) were prescribed hormonal medication to stop their bleeding by providers from the ED, Adolescent Medicine, or Pediatric Gynecology. ED physicians prescribed mostly single-dose and multidose taper combined oral contraceptive pills (85%; n = 24), compared with Adolescent Medicine (54%, n = 7), and Gynecology (28%, n = 13). Pediatric gynecologists were more likely than ED physicians to treat patients with norethindrone acetate, either alone or in combination with a single dose combined oral contraceptive pill (61%, n = 33 vs 7%, n = 2; P < .001).
  
  
  CONCLUSIONS
  Variations in treatment strategies for adolescents who present with acute AUB exist among pediatric specialties, which reflects a lack of standardized care for adolescents. Prospective evaluation of the shortest interval to cessation of bleeding, side effects, and patient satisfaction are valuable next steps.
authors.affiliation: Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: Patricia.Huguelet@ucdenver.edu.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Huguelet
authors.affiliation: Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Eliza M
authors.initials: EM
authors.lastname: Buyers
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jill H
authors.initials: JH
authors.lastname: Lange-Liss
authors.affiliation: Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods*; D002648:Child; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006176:Gynecology / Q000379:methods*; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy; D008599:Menstruation Disturbances / Q000188:drug therapy; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077563:Norethindrone Acetate; D010372:Pediatrics / Q000379:methods*; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D003277:Contraceptives, Oral, Combined; D000077563:Norethindrone Acetate; D009640:Norethindrone
keywords: Acute abnormal uterine bleeding; Adolescents; Treatment