Reducing unnecessary investigations in adolescent gynaecology: The utility of pelvic ultrasonography for adolescents presenting with heavy menstrual bleeding.

Abstract

Heavy menstrual bleeding (HMB) in adolecents is predominantly related to an immature hypothalamic-pituitary-ovarian axis. Structural causes in this population are extremely rare; therefore, pelvic ultrasonography is not required as a first-line investigation. Anecdotally, it has been observed that pelvic ultrasounds of adolescents with HMB are normal and do not change clinical care. The aim of this study was to analyse all female patients aged ≤18 years who were referred to a tertiary paediatric hospital for HMB over a 12-month period. Medical records were reviewed to determine if pelvic ultrasonography was ordered during the diagnostic process and whether the imaging altered management. No pelvic ultrasounds ordered for adolescents with HMB altered clinical management. General practitioners (GP) were the most likely to refer patients to the tertiary paediatric hospital and to order pelvic ultrasonography, likely reflecting that most female adolescents are seen by a GP within the community. Providing clinical updates and ongoing education to health professionals managing female adolescent patients is recommended.