title: The Utility of Routine Ultrasound in the Diagnosis and Management of Adolescents with Abnormal Uterine Bleeding.
abstract: OBJECTIVE
  Despite the fact that most cases of abnormal uterine bleeding (AUB) in adolescence are due to an immature hypothalamic-pituitary-ovarian (HPO) axis, the current approach to investigating adolescents who present with AUB often includes pelvic ultrasound to exclude rare structural causes. The aim of this study was to determine whether an ultrasound ordered for the investigation of AUB in adolescents detects any significant anatomic pathology or alters diagnosis and management.
  
  
  METHODS
  A retrospective chart review of 230 patients younger than 18 years of age who presented with AUB to the gynecology clinic at the Hospital for Sick Children in Toronto, Canada between January 2010 and December 2012 was completed.
  
  
  METHODS
  Findings on pelvic ultrasound and any further imaging as well as management choices for these patients were examined.
  
  
  RESULTS
  Of all patients, 67.8% (156/230) had ultrasound done as part of their AUB workup. The most common diagnosis for the patients who received ultrasound examinations and the patients who did not was AUB due to an immature HPO axis. Of the patients who received an ultrasound examination, 72.4% (113/156) had normal findings; incidental findings were identified in 17.9% (28/156) and polycystic ovary syndrome morphology in 6.4% (10/156). Structural causes of AUB were found in only 2 (1.3%) of the adolescents imaged. No patient had a change in her AUB management plan because of ultrasound findings.
  
  
  CONCLUSIONS
  Our results strongly suggest that pelvic ultrasound examination is not required in the initial investigation of AUB in the adolescent population because it did not alter treatment in any of our patients.
authors.affiliation: Section of Pediatric and Adolescent Gynecology, Department of Endocrinology, Hospital for Sick Children Toronto, Ontario, Canada. Electronic address: ypecchioli@qmed.ca.
authors.forename: Yael
authors.initials: Y
authors.lastname: Pecchioli
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lamide
authors.initials: L
authors.lastname: Oyewumi
authors.affiliation: Section of Pediatric and Adolescent Gynecology, Department of Endocrinology, Hospital for Sick Children Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Allen
authors.affiliation: Section of Pediatric and Adolescent Gynecology, Department of Endocrinology, Hospital for Sick Children Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sari
authors.initials: S
authors.lastname: Kives
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000000981:diagnostic imaging; D010913:Pituitary-Adrenal System / Q000000981:diagnostic imaging; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Abnormal uterine bleeding; Adolescents; Menstruation; Pelvic ultrasound