Abnormal Uterine Bleeding in Adolescence

Abstract

Abnormal uterine bleeding is a common gynaecological problem among adolescents and is frequently related to immaturity of the hypothalamic–pituitary–ovarian axis and anovulatory menstrual cycles. Careful evaluation is required to exclude pregnancy, bleeding disorders, endocrine abnormalities and structural pathology, as untreated bleeding may cause iron deficiency, anaemia, haemodynamic instability and impaired quality of life. This study aimed to assess the bleeding patterns, causes, clinical presentation and diagnostic evaluation of abnormal uterine bleeding among adolescents. A cross-sectional observational study was conducted at Basra Maternity and Children Teaching Hospital between 1 November 2025 and 1 October 2026. It included 94 consecutive adolescent girls aged 10–19 years who presented with abnormal uterine bleeding. Participants underwent standardised clinical assessment and physical examination, supported by selective laboratory and ultrasonographic investigations. Bleeding severity and menstrual abnormalities were classified using established clinical and guideline-based definitions. The mean age of participants was 15.97 ± 1.38 years. Metrorrhagia was the most frequent menstrual abnormality, affecting 53.2% of participants, followed by oligomenorrhoea in 17.0%. Mild bleeding was most common, occurring in 51.1%, whereas 20.2% experienced severe bleeding. Clinical signs of androgen excess were identified in 40.4%, low serum ferritin in 39.4%, and polycystic ovarian morphology on ultrasonography in 47.9%. Ultrasonographic findings were significantly associated with body mass index (p = 0.021) and menstrual abnormality patterns (p = 0.038), but not with age (p = 0.312). In conclusion, adolescent abnormal uterine bleeding most commonly presented as mild metrorrhagia. Iron deficiency, anaemia and polycystic ovarian morphology were frequent, highlighting the importance of comprehensive clinical, haematological and endocrine evaluation.