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Cited by 8Genetic and Clinical Aspects of Sex Determination and Chromosomal AbnormalitiesSexual Differentiation and DisordersMenstrual Health and Disorders

Abnormal uterine bleeding during pubertal induction with transdermal estrogen in individuals with Turner syndrome

Shim, Sarah, Streich-Tilles, Tara, Gutmark-Little, Iris, Yao, Michael, Shafer, Jessica, Breech, Lesley, Casnellie, Lori, Backeljauw, Philippe·2023·Journal of Pediatric and Adolescent Gynecology
DOI 10.1016/j.jpag.2023.03.004
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Abstract

Study objective Incidence of abnormal uterine bleeding (AUB) during pubertal induction among individuals with Turner syndrome (TS) has not been described previously. We estimated the incidence and characterized factors associated with AUB among individuals with TS. A secondary objective was to evaluate the management of AUB among this patient population.Design, setting, participants, and intervention We conducted a retrospective chart review to evaluate individuals with TS undergoing hormone replacement therapy (HRT) for pubertal induction with transdermal estrogen. A total of 45 participants were identified between January 2007 and June 2019.Results Of the 45 individuals with TS included, 16 (35%) experienced AUB. Individuals with AUB most commonly experienced prolonged (44%), prolonged and heavy (25%), and intermenstrual (19%) bleeding. Individuals who experienced AUB were more likely to experience spontaneous bleeding (69% vs 28%) and a duration of unopposed estrogen greater than 18 months (63% vs 41%), undergo progestin cycling less often than monthly (69% vs 0%), use a micronized progestin dose of less than 200 mg (25% vs 14%), and be noncompliant with HRT (19% vs 0%) compared with those who did not experience AUB.Conclusion There is a relatively high incidence of AUB among individuals with TS undergoing pubertal induction with transdermal estrogen. Care providers should consider the clinical factors examined to guide monitoring and management of individuals with TS on HRT.

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  • Recent data suggest that girls with Turner syndrome who initiate progesterone closer to 18 months into estrogen treatment may have less abnormal uterine bleeding.

    “Recent data suggest that girls with TS who initiate progesterone closer to 18 months into estrogen treatment may have less abnormal uterine bleeding.”

    From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [310]

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Authors
Shim, S., Streich-Tilles, T., Gutmark-Little, I., Yao, M., Shafer, J., Breech, L., Casnellie, L., & Backeljauw, P.
Affiliations
Cincinnati Children's Hospital Medical Center (US)
Corresponding author
Shim, Sarah
ORCID
Venue
Journal of Pediatric and Adolescent Gynecology
Publisher
Elsevier BV
Published
2023-08
Volume
36
Issue
4
Pages
358-362
ISSN
  • 0932-8610 (ISSN-L)
  • 1083-3188
DOI
10.1016/j.jpag.2023.03.004
OpenAlex
W4327702708
Cited by
8
References
8
Citations by year
2025: 1 · 2024: 4 · 2023: 3
FWCI
1.33
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Pediatric and Adolescent Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Keywords
Turner syndrome, abnormal uterine bleeding, puberty induction, transdermal estrogen, hormone replacement therapy, unopposed estrogen, bleeding risk factors
MeSH terms
Estradiol, Estrogens, Female, Humans, Progestins, Retrospective Studies, Turner Syndrome, Uterine Diseases, Uterine Hemorrhage

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