The Correlation Between Abnormal Uterine Bleeding in Early Menarche and PCOS Later in Adolescence

Abnormal uterine bleeding (AUB) is a frequent reason for concern between adolescents. The most common cause of AUB in these girls, when other pathologies have been excluded, is anovulation, due to immaturity of the hypothalamic-pituitary-ovarian axis. Several similarities seem to be present in adolescents with AUB at the first years after menarche, especially those with persistent anovulation after these years and adolescents with the diagnosis of polycystic ovary syndrome (PCOS) later in their life. These are the increased ovarian and adrenal steroidogenesis, the hyperpulsatile gonadotropin secretion, the hyperinsulinemia and insulin resistance, and the anovulation, which leads to menstrual irregularity, including AUB. Anovulation, which can be first expressed as AUB at perimenarchal age, may persist and strengthen PCOS diagnostic criteria sometime during lifetime. Thorough attention should be paid, by specialized doctors in pediatric and adolescent gynecology, in AUB cases after menarche, while proper follow-up of these girls is mandatory, due to their increased risk to manifest PCOS in the near future.