Paeds Cases · adolescent-and-young-adult-medicine
Dysmenorrhoea and heavy menstrual bleeding — structured clinical encounter
Structured encounter testing the approach to a 13-year-old with heavy menstrual bleeding from menarche: quantifying the bleeding, recognising the bleeding-disease screen, applying the FIGO PALM-COEIN classification, and running the management ladder with iron repletion and follow-up.
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Station brief (candidate)
You are the general paediatric registrar in adolescent clinic. A 13-year-old is brought by her mother with heavy periods since her first menstrual period at menarche eight months ago. She soaks a pad every 1 to 2 hours on heavy days, passes clots, and tires easily. Her mother mentions the young person bruises easily and bled after a recent dental extraction, and that she herself had a hysterectomy for menorrhagia. The team asks you to assess the problem, decide on investigations, and outline the management plan. You have 12 minutes with the young person and her mother and 5 minutes for examiner discussion. [4]
References5ShowHide
- [1]ACOG Committee on Adolescent Health Care ACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstet Gynecol, 2018.PMID 30461694
- [2]ACOG Committee on Adolescent Health Care ACOG Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstet Gynecol, 2015.PMID 26595586
- [3]Munro MG; Critchley HOD; Fraser IS; FIGO Menstrual Disorders Committee The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet, 2018.PMID 30198563
- [4]Hernandez A; Dietrich JE Abnormal Uterine Bleeding in the Adolescent. Obstet Gynecol, 2020.PMID 32028485
- [8]Bofill Rodriguez M; Lethaby A; Jordan V Progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev, 2020.PMID 32529637