title: Polycystic Ovary Syndrome: An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital.
abstract: OBJECTIVE
  To evaluate whether ovulatory dysfunction due to polycystic ovary syndrome (PCOS) is a common underlying etiology of abnormal uterine bleeding (AUB) in adolescents who require hospitalization and to explore etiology, treatment, and complications of AUB with severe anemia in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We identified female patients aged 8-20 years admitted to a children's hospital for treatment of AUB from January 2000 to December 2014. Our hospital protocol advises hormonal testing for PCOS and other disorders before treatment for AUB. We reviewed medical records and recorded laboratory evaluations, treatments, and final underlying diagnoses as well as recurrences of AUB and readmissions in the subsequent year.
  
  
  RESULTS
  Of the 125 subjects, the mean age was 16.5 ± 2.9 years; mean hemoglobin level was 7.0 ± 1.8 g/dL; 54% were overweight/obese; and 41% sexually active. PCOS accounted for 33% of admissions; hypothalamic pituitary ovarian axis immaturity 31%; endometritis 13%; bleeding disorders 10%. Girls with PCOS were more likely to be overweight/obese (74% vs 46%; P < .01) and girls with hypothalamic pituitary ovarian axis immaturity had lower hemoglobin levels (6.4 g/dL vs 7.4 g/dL; P < .05), than girls with all other etiologies of AUB. Treating physicians failed to diagnose endometritis as the etiology for AUB in 4 of 8 girls with positive tests for sexually transmitted infection and no other etiology.
  
  
  CONCLUSIONS
  PCOS was the most common underlying etiology in adolescents hospitalized with AUB. Screening for hyperandrogenemia is important for early diagnosis of PCOS to allow ongoing management and prevention of comorbidities. Endometritis was frequently underestimated as an etiology for AUB.
authors.affiliation: Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York. Electronic address: smaslyan@montefiore.org.
authors.forename: Sofya
authors.initials: S
authors.lastname: Maslyanskaya
authors.affiliation: Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Hina J
authors.initials: HJ
authors.lastname: Talib
authors.affiliation: Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Northridge
authors.affiliation: Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Jacobs
authors.affiliation: Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Chanelle
authors.initials: C
authors.lastname: Coble
authors.affiliation: Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Coupey
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000175:diagnosis; D014592:Uterine Hemorrhage / Q000209:etiology*; D055815:Young Adult
keywords: Abnormal uterine bleeding; Adolescent; Anemia; Endometritis; Menorrhagia; Polycystic Ovary Syndrome