Paeds Cases · adolescent-and-young-adult-medicine
Menstrual disorders in adolescents — OSCE: heavy menstrual bleeding assessment and plan
Observed structured encounter testing confidential adolescent history, objective FIGO description of heavy menstrual bleeding, a focused work-up rationale, and a shared mechanism-based plan.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 14-year-old presents 18 months after menarche with heavy, prolonged menses, fatigue and missed school. The candidate must take a confidential adolescent history, describe the bleeding in FIGO terms, justify the work-up including von Willebrand screening, and agree a shared management plan.
Station objectives
- Establish a confidential adolescent frame with conditional confidentiality. [1]
- Take an objective menstrual history using FIGO descriptors and practical volume prompts. [2] [5]
- Justify a focused work-up including pregnancy test, full blood count, ferritin, and von Willebrand screening. [3] [4]
- Agree a shared, mechanism-based management plan with iron treatment and follow-up. [3]
References7ShowHide
- [1]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstetrics and gynecology, 2015.PMID 26595586
- [2]Munro MG, Critchley HO, Fraser IS The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertility and sterility, 2011.PMID 21496802
- [3]Borzutzky C, Jaffray J Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA pediatrics, 2020.PMID 31886837
- [4]American College of Obstetricians and Gynecologists Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG Committee Opinion, Number 785. Obstetrics and gynecology, 2019.PMID 31441825
- [5]Munro MG, Critchley HOD, Fraser IS 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. International journal of gynaecology and obstetrics, 2018.PMID 30198563
- [6]Iacovides S, Avidon I, Baker FC What we know about primary dysmenorrhea today: a critical review. Human reproduction update, 2015.PMID 26346058
- [7]Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ Polycystic ovary syndrome. The lancet. Diabetes and endocrinology, 2022.PMID 35934017