Menstrual Irregularities: Abnormal Vaginal Bleeding
It is common for girls to have irregular menstrual cycles in the first 2 years after menarche. This is usually due to a lack of maturity of the hypothalamic–pituitary–ovarian axis controlling the menstrual cycle. Most girls are anovulatory during this time. The clinician may see young postmenarchal girls with the complaint of irregular or heavy vaginal bleeding. Although dysfunctional uterine bleeding, which is due to immaturity of the hypothalamic-pituitary-ovarian axis, may be the explanation for many of these issues, it is important to consider other systemic as well as gynecologic causes of the bleeding before assuming dysfunctional uterine bleeding (DUB) is the etiology for the bleeding.