Is treatment of AUB in adolescents standardized?
Results of a retrospective study by the North American Society for Pediatric and Adolescent Gynecology (NASPAG) underscores differences among providers in management of adolescents with abnormal uterine bleeding (AUB). Conducted by investigators from the University of Colorado, the research suggests a need to prospectively look at the shortest interval to cessation of bleeding, side effects, and patient satisfaction in this patient population.
Published in the Journal of Pediatric and Adolescent Gynecology, the report is based on a chart review of 150 females ages 9 to 22 who presented to a tertiary care medical center Emergency Department (ED) between July 2008 and June 2014 with a complaint of acute AUB. The authors identified records to be analyzed using ICD-9 codes for heavy menstrual bleeding, AUB, and irregular menses. Females who were pregnant or using hormonal therapy were excluded.
The researchers found that for 92 patients (61%), ED, Adolescent Medicine, and Pediatric Gynecology providers chose hormonal medication to stop bleeding. The ED physicians were more likely to prescribe single-dose or multi-dose taper combined oral contraceptives (COCs) than were their colleagues in Adolescent Medicine or Pediatric Gynecology (85%, n=24 vs 54%, n=7 and 28%, n=13, respectively). Pediatric gynecologists, in contrast, were more likely than ED specialists to use norethindrone acetate, either alone or in combination with COCs (61%, n=33 versus 7%, n=2; P<0.001).
The NASPAG authors concluded that the variation in treatment strategies demonstrated a lack of standardization of care for adolescents with acute AUG and a need for prospective research in this area.