Original Study| Volume 30, ISSUE 3, P349-355, June 2017

Download started.


Polycystic Ovary Syndrome: An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital

Published:November 26, 2016DOI:


      Study 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.


      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.


      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.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Knox B.
        • Azurah A.G.
        • Grover S.R.
        Quality of life and menstruation in adolescents.
        Curr Opin Obstet Gynecol. 2015; 27: 309
        • Ziv A.
        • Boulet J.R.
        • Slap G.B.
        Utilization of physician offices by adolescents in the United States.
        Pediatrics. 1999; 104: 35
        • Verma A.
        • Mulchandani R.
        • Lauria N.
        • et al.
        Analysis of menstrual cycle irregularities in adolescent girls in a tertiary care hospital.
        Evol Med Dent Sci. 2013; 2: 4638
        • Bevan J.A.
        • Maloney K.W.
        • Hillery C.A.
        • et al.
        Bleeding disorders: a common cause of menorrhagia in adolescents.
        J Pediatr. 2001; 138: 856
        • Kanbur N.Ö.
        • Derman O.
        • Kutluk T.
        • et al.
        Coagulation disorders as the cause of menorrhagia in adolescents.
        Int J Adolesc Med Health. 2004; 16: 183
        • Falcone T.
        • Desjardins C.
        • Bourque J.
        • et al.
        Dysfunctional uterine bleeding in adolescents.
        J Reprod Med. 1994; 39: 761
        • Smith Y.
        • Quint E.
        • Hertzberg B.
        Menorrhagia in adolescents requiring hospitalization.
        J Pediatr Adolesc Gynecol. 1998; 11: 13
        • Azziz R.
        • Woods K.S.
        • Reyna R.
        • et al.
        The prevalence and features of the polycystic ovary syndrome in an unselected population.
        J Clin Endocrinol Metab. 2004; 89: 2745
        • Desforges J.F.
        • Cowan B.D.
        • Morrison J.C.
        Management of abnormal genital bleeding in girls and women.
        N Engl J Med. 1991; 324: 1710
        • Menstruation in Girls and Adolescents
        Using the Menstrual Cycle as a Vital Sign.
        Obstet Gynecol. 2015; 126: e143
        • Munro M.G.
        • Critchley H.O.
        • Broder M.S.
        • et al.
        FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.
        Int J Gynaecol Obstet. 2011; 113: 3
        • Nandalike K.
        • Strauss T.
        • Agarwal C.
        • et al.
        Screening for sleep-disordered breathing and excessive daytime sleepiness in adolescent girls with polycystic ovarian syndrome.
        J Pediatr. 2011; 159: 591
        • Bellin E.
        • Fletcher D.D.
        • Geberer N.
        • et al.
        Democratizing information creation from health care data for quality improvement, research, and education—the Montefiore Medical Center experience.
        Acad Med. 2010; 85: 1362
        • Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group
        Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).
        Hum Reprod. 2004; 19: 41
        • Kenigsberg L.E.
        • Agarwal C.
        • Sin S.
        • et al.
        Clinical utility of magnetic resonance imaging and ultrasonography for diagnosis of polycystic ovary syndrome in adolescent girls.
        Fertil Steril. 2015; 104: 1302
        • Hickey M.
        • Doherty D.
        • Atkinson H.
        • et al.
        Clinical, ultrasound and biochemical features of polycystic ovary syndrome in adolescents: implications for diagnosis.
        Hum Reprod. 2011; 26: 1469
      1. Colby SL, Ortman JM: Projections of the size and composition of the US population: 2014 to 2060. Available: Accessed December 3, 2016.

        • Christensen S.B.
        • Black M.H.
        • Smith N.
        • et al.
        Prevalence of polycystic ovary syndrome in adolescents.
        Fertil Steril. 2013; 100: 470
        • Zhao Y.
        • Qiao J.
        Ethnic differences in the phenotypic expression of polycystic ovary syndrome.
        Steroids. 2013; 78: 755
        • Sri A.S.
        • Jehan A.
        Pubertal menorrhagia: evaluation and management.
        Evol Med Dent Sci. 2015; 4: 5198
        • Hart R.
        • Doherty D.A.
        • Mori T.
        • et al.
        Extent of metabolic risk in adolescent girls with features of polycystic ovary syndrome.
        Fertil Steril. 2011; 95: 2347
        • Glueck C.J.
        • Morrison J.A.
        • Daniels S.
        • et al.
        Sex hormone-binding globulin, oligomenorrhea, polycystic ovary syndrome, and childhood insulin at age 14 years predict metabolic syndrome and class III obesity at age 24 years.
        J Pediatr. 2011; 159: 308
        • Fauser B.C.
        • Tarlatzis B.C.
        • Rebar R.W.
        • et al.
        Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group.
        Fertil Steril. 2012; 97: 28
        • Hardy T.S.
        • Norman R.J.
        Diagnosis of adolescent polycystic ovary syndrome.
        Steroids. 2013; 78: 751
        • Legro R.S.
        • Arslanian S.A.
        • Ehrmann D.A.
        • et al.
        Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2013; 98: 4565
        • Revel-Vilk S.
        • Paltiel O.
        • Lipschuetz M.
        • et al.
        Underdiagnosed menorrhagia in adolescents is associated with underdiagnosed anemia.
        J Pediatr. 2012; 160: 468
        • Toth M.
        • Patton D.L.
        • Esquenazi B.
        • et al.
        Association between Chlamydia trachomatis and abnormal uterine bleeding.
        Am J Reprod Immunol. 2007; 57: 361
        • Wahba K.
        The prevalence of Chlamydial endometritis in women with menorrhagia at an Egyptian tertiary university hospital.
        J Gynecol Obstetr Bull. 2016; 1: 3
        • Sidonio R.F.
        • Smith K.J.
        • Ragni M.V.
        Cost-utility analysis of von Willebrand disease screening in adolescents with menorrhagia.
        J Pediatr. 2010; 157: 456
        • Committee on Patient Safety and Quality Improvement
        Committee Opinion No. 629: Clinical guidelines and standardization of practice to improve outcomes.
        Obstet Gynecol. 2015; 125: 1027