Objectives: To classify adolescent abnormal uterine bleeding (AUB) according to PALM COIEN classification and its outcome in tertiary care centre.
Material and Methods: This study is observational study, conducted in J K Lone Mother and child hospital, Medical College Kota, from June 2019 to June 2020. Out of all the girls attending OPD, adolescents with non-menstrual complaints, primary amenorrhea and dysmenorrhea were excluded. Finally girls with complaints of heavy period, irregular cycles and oligomenorrhoea (AUB) formed the study group. Complete blood count, PT/aPTT, kidney function test, liver function test and random blood sugar and Thyroid Function Test (TFT) were done in all girls. If PT/aPTT was dear ranged then further coagulation profile was done. Trans abdominal ultrasonography (USG) was done and MRI and CT were also done as per needed. In suspected PCOS cases and girls with obesity, oligomenorrhoea and hirsuitism additional tests like Follicle Stimulating Hormone (FSH), Leutinizing Hormone (LH), Serum Prolactin level, Free Testosterone and insulin level done. The Prevalence of menstrual disorder in adolescent was calculated. Management of cases according to FIGO guideline was done. Treatment of AUB would be based on underlying etiologic and severity of bleeding. Evaluation of menstrual blood loss was assessed using The pictorial blood assessment chart (PBLAC) [1-3]
Results: The mean age of patients was 15.08 years with majority (47.5%) having age between 13-15 years followed by 40% in age group 16-19 years and 12.5% in age group 10-12 years. Here, 90% patients were inn AUB-O class followed by 4.5% in AUB-N, 2.5% in AUB-C, 2% in AUB-I, 0.5% in AUB-L and AUB-P class. According to palm 1% and coein 99%.Out of 180 patients which were in AUB-O class according to Palm Coein classification, 47.2% had immaturity of hypothalamic pituitary ovarian axis followed by 39.4% had PCOS and 13.3% had thyroid disorder.
Conclusion: The study concluded that Menorrhagia in adolescents can be caused by a number of condition, the most common being the immature hypothalamic-pituitary-ovarian axis. Assessment of each case with through history, physical examination, and laboratory in investigation is crucia in reaching the diagnosis. We see that we can successfully apply palm coein approach to adolescent AUB. Although bulk of adolescent. AUB is due to ovulatory disorder. We can conclude from the present study that commonest cause of puberty menorrhagia is immaturity of the hypothalamic- pituitary ovarian axis resulting in anovulation. Anatomical abnormalities like fibroid or polyp are also to be ruled out. Once the diagnosis is made medical or surgical treatment as appropriate is to be administered. Early innervation as soon as students are admitted into higher school of learning would be beneficial in helping them to manage this unavoidable experience without any effect on their health and academic work.