Journal of pediatric and adolescent gynecology最新文献

Objective: To evaluate the prevalence of polycystic ovary syndrome (PCOS) in girls presenting with amenorrhea and to compare the clinical and biochemical features of those with primary (PA) versus secondary amenorrhea (SA).

Methods: We performed a retrospective chart review of girls aged 12-18 years seen in the pediatric endocrine clinic for amenorrhea between 2014 and 2024. PA was defined as absent menses by age 15 or ≥3 years after puberty onset, and SA as cessation of menses for ≥ 6 months one-year post-menarche. Data collected included demographics, family history, clinical features, laboratory studies, response to a progesterone challenge test and treatment. Non-parametric tests (Mann-Whitney U) and chi-square tests were used for comparisons.

Results: Among 377 patients, 126 (33%) were diagnosed with PCOS, of whom 32 (25.4%) had PA and 94 (74.6%) had of SA. Mean age was similar in PA and SA groups (15.2 ± 1.3 vs 15.3 ± 1.5 years). BMI was elevated in both groups (37.1 ± 7.5 vs 36.3 ± 8.4 kg/m²). Family history of PCOS was more frequent in those with PA (31.3% vs 14.9%, p = 0.042). Failure to bleed after a progesterone challenge failure was more common in girls with PA (36.8% vs 14.0%, p = 0.041). Androgen levels were higher in girls with PA (p < 0.05).

Conclusions: PCOS is a frequent cause of both PA and SA in adolescents. Girls with PA exhibit greater hyperandrogenism and are more likely to fail a progesterone challenge, suggesting a more severe phenotype than in those with SA.

Climate change is an escalating global crisis that disproportionately threatens the health and rights of children and adolescents, with girls facing particularly heightened vulnerability. Increasing temperatures, extreme weather events, food and water insecurity, and exposure to environmental toxins directly and indirectly affect sexual and reproductive health. These impacts include altered timing of menarche, worsened dysmenorrhea, increased risks of subfertility and pregnancy complications, and reduced access to essential reproductive health services. Broader climate related instability further contributes to malnutrition, disruption of education, child marriage, displacement, and gender-based violence, compounding longstanding gender, socioeconomic, and geographic inequities. FIGIJ affirms climate change as a health emergency and aligns with international efforts calling for urgent, coordinated action. FIGIJ supports the development of strong coalitions between governments, health care systems and communities, to amplify the healthcare sector's voice in global and regional climate advocacy. Protecting the next generation requires coordinated efforts, effective collaboration and ongoing commitment to supporting a healthier, more resilient and equitable future.

Vaginal rhabdomyosarcoma is a rare malignant soft tissue tumor in pediatric patients, and optimal management aims to achieve tumor control while preserving pelvic organs. We report the case of a 16-month-old girl who presented with a protruding vaginal mass. Imaging studies revealed a vaginal tumor near the cervix without evidence of metastatic disease. Histopathological examination confirmed embryonal rhabdomyosarcoma. The patient received 12 weeks of neoadjuvant VAC/VA chemotherapy followed by laparoscopic tumor resection, which was chosen to address the limited pelvic space in infancy and to preserve surrounding organs. The postoperative course was uneventful, and adjuvant chemotherapy was completed. At 32 months of follow-up, no local recurrence or distant metastasis was observed. This case suggests that laparoscopic resection combined with chemotherapy may represent a feasible and organ-preserving treatment option for selected infants with vaginal rhabdomyosarcoma, although long-term follow-up remains necessary.

Objective: To compare differences by body mass index (BMI) in (1) menstrual characteristics, (2) laboratory evaluation, and (3) hospitalization outcomes among adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department (ED) using a standardized clinical pathway.

Methods: A retrospective chart review was conducted for menstruating patients aged 8-25 years with acute HMB ED encounters at a large tertiary children's hospital network from 2017-2022. Patients were grouped by BMI (<85^th vs ≥85^th percentile). Demographics, menstrual characteristics, and laboratory studies were compared between BMI groups using two-sample hypothesis tests. Among hospitalized patients, the effect of BMI on treatment outcomes of length of stay (LOS), red blood cell (RBC) transfusion, and ongoing HMB requiring secondary medication (tranexamic acid (TXA) utilization) was assessed using logistic regression. Multivariable models were adjusted for medication and laboratory values.

Results: Among the 515 patients with documented BMI, 367 were hospitalized, and received medication (35% norethindrone acetate, 65% IV conjugated estrogen). Patients with elevated BMI more often experienced menarche before age 12 (58% vs 47%, p=0.011). Most demographics and labs did not differ by BMI. Endocrine labs were more frequently drawn for elevated BMI, per clinical pathway recommendations. No significant differences in treatment outcomes were observed by BMI. Multivariable analysis showed no association between BMI ≥ 85^th percentile and prolonged LOS, RBC transfusion, or TXA use.

Conclusion: While menstrual characteristics and laboratory evaluation varied slightly by BMI, management and treatment outcomes did not.

Study objective: To identify factors associated with ovarian-conserving surgery in children, to examine population trends in benign ovarian surgeries over 20 years, and to evaluate long-term risk of subsequent ovarian surgeries.

Methods: We conducted a population-based retrospective cohort study of females <18 years undergoing benign ovarian surgery in Ontario, Canada (2003-2022). Factors associated with ovarian-conserving surgery were identified with multivariable log-binomial regression. Surgical trends (ovarian-conserving surgery, laparoscopy, pediatric hospital utilization) were evaluated using the Cochrane-Armitage test. Cumulative incidences of subsequent surgeries were estimated with Kaplan-Meier analysis and compared using log-rank tests.

Results: Among 3,452 children (median age 15 years), 2,827 (81.9%) underwent ovarian-conserving surgeries and 625 (18.1%) oophorectomies. Ovarian-conserving surgery was more likely with laparoscopy (RR 1.40, 95%CI 1.33-1.47), female surgeons (RR 1.04; 95%CI 1.01-1.07), and non-gynecologist (RR 1.04; 95%CI 1.01-1.08), and less likely in rural patients (RR 0.93, 95%CI 0.88-0.98) and younger children (RR 0.84, 95%CI 0.75-0.94). Although rates of surgery remained stable, there was an increase in laparoscopy (63% to 83%, p<0.0001), pediatric hospital use (32% to 56%, p<0.0001), and ovarian-conserving surgeries (80% to 87%, p<0.0001). Cumulative incidence of subsequent ovarian surgery rose with time after index operation, remaining higher after ovarian-conserving surgery than oophorectomy (p<0.0001).

Conclusions: Adoption of minimally invasive techniques and specialized pediatric care is increasing. Persistent risk of reoperation among all patients in this cohort highlights the need for strategies to ensure appropriate follow up for this at-risk group, promoting ovarian preservation, and equitable access to pediatric gynecologic expertise.

Study objective: Fear of weight gain is a feature of many eating disorders (EDs). We examined patient-reported side effects and the need for menstrual management after long-acting reversible contraception (LARC) insertion among a matched cohort of adolescent and young adults (AYAs) with and without EDs.

Methods: Patients with EDs were matched with patients without EDs based on factors including age, device type, LARC indication, and weight status. We examined associations between EDs and reported side effects, and the need for medication-based menstrual management (any medication or hormonal-only) using mixed-effects logistic regression models, accounting for clustering within matched groups.

Results: We included 313 patients (mean age=18.5, age range=13.4, 24.7), of which 58 (18.5%) had EDs and 255 (81.5%) did not. There was no difference between patients with and without EDs in the likelihood of reporting LARC concerns, either any side effect (OR=1.39; 95% CI: 0.72, 2.69), or pelvic pain specifically (OR=0.83; 95% CI: 0.35, 1.97). However, in adjusted models, patients with EDs had 1.96 times the odds of reporting unsatisfactory bleeding compared to those without (95% CI: 1.04, 3.69). There was no difference in the receipt of medication-based menstrual management between patients with and without EDs.

Conclusion: Patients with EDs reported a higher prevalence of unsatisfactory bleeding with LARC use, though we saw no between-group differences in the receipt of medication-based menstrual management. These findings highlight the importance of proactively counseling AYAs with EDs about potential bleeding changes after LARC insertion.

Background: Primary epithelial ovarian malignancies in adolescents are extremely rare (<1%). Mucinous cystadenocarcinoma (MCAC), especially bilateral disease, is exceptional and often mimics benign ovarian cysts, delaying the diagnosis.

Case: We report a 16-year-old girl with hypothyroidism who presented with abdominal distension, pain, and 20-kg weight gain. Imaging showed bilateral ovarian masses with omental nodularity despite normal tumor markers. Surgery confirmed FIGO IIIC bilateral MCAC, and she completed six cycles of paclitaxel-carboplatin.

Conclusion: At three‑ year follow‑ up, the patient continues to be disease‑ free. This case highlights the limitations of tumor markers in adolescent ovarian malignancy, emphasizes the importance of cross‑ sectional imaging and clinical correlation, and demonstrates the challenges of management including considerations of future fertility.

The U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) and the U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) offer evidence-based guidelines to support the safe and effective provision of contraceptive services. Updated in 2024 and endorsed by the North American Society for Pediatric and Adolescent Gynecology, these documents serve as critical resources for clinicians, particularly those caring for adolescents. The guidelines play an essential role in promoting equitable, high-quality contraceptive care and reducing unintended pregnancy among adolescents. This review aims to summarize key updates to the U.S. MEC and U.S. SPR that are most relevant to adolescents in order to facilitate broader dissemination and practical implementation of current recommendations among this population. The summary is designed to complement, not replace, the comprehensive guidance provided in the full U.S. MEC and U.S. SPR documents.

Purpose: Heavy menstrual bleeding (HMB) is a common cause of iron deficiency (ID). The COVID-19 pandemic was associated with reduced access to routine healthcare with significant impacts on women's health. The aim of this study is to improve our understanding of the effect of the pandemic associated lockdown on diagnosis and management of HMB and ID.

Methods: An IRB-approved retrospective chart review was conducted on patients assigned female at birth aged 11-25 with HMB and ID presenting to Hasbro Children's hematology clinic or inpatient service between March 2018 and February 2023. Patients were identified using ICD-10 codes and manual chart review.

Results: Of 224 patients included, 155 had iron deficiency anemia (IDA) and 69 had iron deficiency without anemia (IDwA). The annual incidence of IDA due to HMB increased by twofold from pre-pandemic levels (n=14, 2018-2019; n=18, 2019-2020) to pandemic/post-pandemic levels (n=36, 2020-2021; n=46, 2021-2022; n=41, 2022-2023) (p<0.001). Patients with IDA presenting during the pandemic were more likely to be treated in the acute care setting than outpatient (69.4% vs 30.6%, respectively) compared to pre-pandemic (46.9% vs 53.1%) and post-pandemic (36.8% vs 63.2%) groups (p=0.004), and were more likely to have received a blood transfusion or intravenous iron (50% and 44.4%, respectively) when compared to pre-pandemic (28.1%, 12.5%) and post-pandemic (20.7%, 39.1%) groups (p=0.006, p=0.008).

Discussion: This study reveals a significant increase in both disease severity and incidence of IDA due to HMB during and after the pandemic, likely due to reduced access to preventive care.