Dysfunctional uterine bleeding in the pediatric and adolescent patient

The pediatric patient with vaginal bleeding usually presents to the pediatrician. The importance of a thorough history and physical cannot be overemphasized. This review discusses the signs and symptoms associated with the various etiologies. The adolescent patient with abnormal vaginal bleeding may present to the gynecologist or pediatrician. Dysfunctional uterine bleeding is only a diagnosis of exclusion and should only be considered after a complete evaluation. Although an immature hypothalamic-pituitary-ovarian axis is common in the immediate years after menarche, an adolescent with a coagulopathy may initially present as abnormal vaginal bleeding. The differential diagnosis of abnormal vaginal bleeding is discussed as is the treatment of dysfunctional uterine bleeding.