Journal of pediatric and adolescent gynecology最新文献

{"title":"20. Bleeding Profiles, Iron Deficiency, and Quality of Life in Two Cohorts of Adolescents and Young Adults with Type 1 Von Willebrand Disease and Joint Hypermobility/Ehlers-Danlos Syndrome","authors":"Anindita Varshneya ,&nbsp;Maria Barrett ,&nbsp;Marie-Teresa Colbert ,&nbsp;Kendra Hutchens ,&nbsp;Genevieve Moyer ,&nbsp;Lauryn Roth ,&nbsp;Patricia Huguelet","doi":"10.1016/j.jpag.2025.01.053","DOIUrl":"10.1016/j.jpag.2025.01.053","url":null,"abstract":"<div><h3>Background</h3><div>Patients with Type 1 Von Willebrand Disease (VWD) experience heavy menstrual bleeding (HMB) and other bleeding symptoms that negatively impact their quality of life. Individuals with Generalized Joint Hypermobility (GJH) and hypermobile Ehlers-Danlos Syndrome (hEDS) also experience HMB and non-menstrual bleeding, likely due to abnormalities of collagen production. Limited research exists regarding the sequelae of HMB among these populations, including iron deficiency, and impact on school attendance and behavioral health. We aim to describe HMB, rates of iron deficiency, need for intravenous iron, and impact on school attendance and mood in adolescents and young adults with Type 1 VWD and GJH/hEDS.</div></div><div><h3>Methods</h3><div>We performed an IRB-approved, retrospective chart review of patients aged 10-25, presenting with HMB to a combined gynecology/hematology clinic at a tertiary children's hospital from 2019-2024. Cohort 1 included patients with Type 1 VWD. Cohort 2 included patients with GJH (Beighton score ≥ 4) or hEDS (confirmed by a geneticist). Extracted data included baseline demographics, bleeding assessment scores, baseline hemoglobin and ferritin levels, presence of depression or anxiety, and treatments prescribed. Descriptive data are summarized using mean and standard deviation, median and ranges.</div></div><div><h3>Results</h3><div>Cohort 1 (VWD) included 111 patients; Cohort 2 (GJH, hEDS) included 26 patients. Table 1 reports baseline demographics in both cohorts. Patients in both cohorts had high scores on baseline Bleeding Assessment Tool (BAT) and pictorial blood loss assessment chart (PBAC) (Table 2). Anxiety and depression were reported by 51% of individuals with VWD and 65% GJH/hEDS patients. Intravenous iron was needed for 54% VWD and 65% GJH/hEDS. Median total lines of treatment were 2 (VWD) and 3 (hEDS). Among patients who achieved bleeding improvement, defined by PBAC &lt; 100, the LNG-IUD (alone or with supplemental therapy) was successful for 62% GJH/hEDS and 33% VWD.</div></div><div><h3>Conclusions</h3><div>Patients with GJH/hEDS and Type 1 VWD demonstrate similar bleeding profiles. These patients attempt several lines of therapy to control HMB. Patients with GHJ/hEDS demonstrate a trend towards higher rates of depression and anxiety and a greater need for intravenous iron. Our results suggest greater awareness and treatment guidelines are needed for patients with GJH/hEDS. Future analyses will compare the two cohorts and will assess the most effective treatment modalities.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 239-240"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"56. Informing Educational Initiatives: Sources and Satisfaction of Menstrual Education Among Young Women in a Multi-State Study","authors":"Jacquelyn Golden,&nbsp;Ana tomlinson,&nbsp;Garrett Forman,&nbsp;Lisa Gwynn","doi":"10.1016/j.jpag.2025.01.089","DOIUrl":"10.1016/j.jpag.2025.01.089","url":null,"abstract":"<div><h3>Background</h3><div>Period poverty (inadequate access to resources and knowledge regarding menstruation management) has been observed in college students, despite their access to higher education. This study aims to explore experiences seeking guidance for menstrual problems and education preferences, while investigating correlations between guidance sources and satisfaction. The findings may inform future menstrual health education initiatives for young women.</div></div><div><h3>Methods</h3><div>A Qualtrics survey was distributed via snowball sampling to females enrolled in U.S. undergraduate programs. Information collected included demographics, preferences on menstrual education, and experiences with seeking help with menstrual problems. Chi-square goodness of fit and independence tests were performed using SPSS v29.</div></div><div><h3>Results</h3><div>Results from 102 participants across 9 states were analyzed. The majority were White (91.2%) and Non-Hispanic (89.2%), with ages ranging from 18 to 28 (average 19.6, SD±1.62). Of the respondents, 76.5% graduated from public high school, 19.6% from private high school, 2.9% foreign high school, and 0.9% trade school. The significantly preferred setting for menstrual education was doctors’ offices (25.48%, p&lt; 0.001), followed by online (18.25%), home (14.83%), and social media (14.83%). School was significantly least preferred, with small groups (14.07%, p=0.025) favored over auditoriums (12.55%, p=0.002). Top topics of interest for learning about in school included when to see a doctor for menstrual health issues (15.33%, p&lt; 0.001) and signs of common menstrual problems (14.18%, p=0.010). A preference for learning about free or discounted period products in small groups approached significance (p=0.059). Satisfaction levels varied by source of help. Higher satisfaction was reported by those consulting mothers (p&lt; 0.001) or healthcare providers (p=0.02). Interestingly, despite a slight preference for online learning, satisfaction decreased for those seeking help online (p=0.014), and women were dissatisfied if they did not seek help at all (p&lt; 0.001).</div></div><div><h3>Conclusions</h3><div>To address period poverty among college students, it is crucial to prioritize accessible education from trusted sources, particularly healthcare providers and family, while fostering supportive environments in both academic and home settings. Key initiatives in schools should focus on recognizing common menstrual issues and knowing when to seek medical help. Additionally, information about free or discounted menstrual products should be provided in small groups.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 255"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"50. How Well are we Writing to Patients? A Review of Clinical Correspondence from a Tertiary Paediatric and Adolescent Gynaecology Centre","authors":"Charlotte Porter-Hope ,&nbsp;Ker Yi Wong ,&nbsp;Hazel Isabella Learner","doi":"10.1016/j.jpag.2025.01.083","DOIUrl":"10.1016/j.jpag.2025.01.083","url":null,"abstract":"<div><h3>Background</h3><div>It's recognised that patient engagement with healthcare is improved when letters are addressed and written directly to them. Adolescents and Young adults have different communication requirements; providing clinical communication with accessible language is thought to improve patient outcomes. Since 2018, clinicians in the UK have been advised to address all clinic letters directly to patients – this audit aimed to identify compliance with this national guidance.</div></div><div><h3>Methods</h3><div>A retrospective audit of outpatient clinic letters written to patients in January 2024, from a tertiary Paediatric and Adolescent gynaecology service, was undertaken. The clinical concern, patient age, learning needs, and who the letter was addressed to was recorded. For letters written to the patient, there was a subjective review of readability with assessment for presence of un-explained medical jargon and caculation of Flesch Reading Ease scores.</div></div><div><h3>Results</h3><div>There were 125 clinic consultations reviewed. The median patient age was 17 years old (2-51years). Clinical context varied and included 53/125 appointments about menstrual dysfunction, 27/125 mullerian anomalies, 20/125 Differences of Sex Development conditions and 10/125 vulval issues. The majority of letters were addressed directly to the patient (100/125 80%). The rest (25/125 20%) were addressed to the referring doctor. In 9/25 this was appropriate given a child's young age or a young person with learning needs. In 10/25 consultation notes were sent out as clinical correspondence, 5 consultations did not have a clinic letter for the appointment, and one letter was written directly to family doctor requesting referral to a service more local to the patient. Most letters written to patients were analysed subjectively to have recipient appropriate language (92%). Unexplained jargon included in letters included: contraindicated, hirsutism, malignant and laparoscopy. Flesch Reading Ease score was on average 51.5, which corresponds to being fairly difficult to read.</div></div><div><h3>Conclusions</h3><div>Generally, clinic letters were found to have good adherence to national guidance and addressed the patient. Although largely correspondence was written to patients was jargon free, objective assessment of Flesch Reading Ease score suggests that letters readability could be improved.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 253"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"46. Genital differences with Congenital Adrenal Hyperplasia- adolescent choices. A retrospective review of new patients seen in a specialist multi-disciplinary service between 2018-2024.","authors":"Hazel Isabella Learner ,&nbsp;Manju Netto ,&nbsp;Sophie Clarke","doi":"10.1016/j.jpag.2025.01.079","DOIUrl":"10.1016/j.jpag.2025.01.079","url":null,"abstract":"<div><h3>Background</h3><div>Congenital Adrenal Hyperplasia(CAH) is associated with genital differences including urogenital sinus anomalies and clitoral enlargement. Surgery in childhood is criticised as non-consensual genital surgery associated with risks and without functional indication in children. In adolescent and adult services surgery can be considered in mature individuals. There is limited data on the decisions of patients in these services considering genitoplasty. This project aimed to describe the decisions of patients with CAH referred to a specialist multi-disciplinary service for genital differences.</div></div><div><h3>Methods</h3><div>A 6-year retrospective review of new adolescent patients(aged 10-25) referred with genital differences associated with CAH to a specialist multi-disciplinary clinic with gynaecology, psychology, clinical nurse specialist and endocrinology. Data was extracted from electronic patient records on demographics, medical history and clinic outcomes. The data was analysed on Excel.</div></div><div><h3>Results</h3><div>Fifty-eight patients were identified with a median age at first appointment of 17years (10-25years). There was no issue with menstrual obstruction or recurrent urinary tract infections in any patients. The majority (34/58 58%) of patients had undergone genital surgery in infancy: 24/58 vaginal and clitoral surgery, 6/58 vaginoplasty, 2/58 clitoral reduction. Of these, three had had repeat procedures in childhood on either their vagina (2/3) or clitoris (1/3). There were 8/34 who were unaware, and 8/34 unsure,of what genital surgery they had previously had. One third of patients (23/58 39%) did not want to proceed with review of their genital differences preferring to defer the option of examination. 8/23 of these young people had not previously undergone surgery (with 1/8 late onset). Of those wanting to explore genital differences, 22/35 were planned for examination under anaesthesia (11/22 also having psychology input to support them considering clitoral concerns and options). There were 7/35 patients with clitoral issues and raised testosterone were planned for psychology and endocrinology input ahead of further gynaecology review. Six (6/635) patients following examination in clinic were offered vaginal dilation therapy, 4/35 felt ready to start this.</div></div><div><h3>Conclusions</h3><div>Genital differences with CAH, can be explored with the support of a specialised MDT service, at a time that is led by the individual affected.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 250"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"49. Hormonal contraceptive considerations in the setting of venous thromboembolism and absent inferior vena cava: A case report","authors":"Elizabeth Baldor ,&nbsp;Madeline Ross ,&nbsp;Emily Orscheln ,&nbsp;Tazim Dowlut-McElroy","doi":"10.1016/j.jpag.2025.01.082","DOIUrl":"10.1016/j.jpag.2025.01.082","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) risk among users of contraception varies based on the hormonal composition of each method. Controversy exists regarding the use of hormonal contraception in those with a history of thrombosis or thrombophilia and require anticoagulation therapy.</div></div><div><h3>Case</h3><div>A 17 y.o. girl presented with persistent pain and swelling in both of her legs. Ultrasound confirmed bilateral femoral vein thromboses; CT revealed absence of the inferior vena cava (AIVC) with extensive thromboses through the iliac and femoral veins. She received therapeutic anticoagulation and mechanical thrombectomy. She reported a history of heavy menses and desired to initiate hormonal contraception for mitigation of heavy menstrual bleeding ultimately choosing the drospirenone 4mg contraceptive pill.</div></div><div><h3>Comments</h3><div>AIVC is a rare anomaly that affects &lt; 1% of the population but commonly presents with lower extremity DVTs in young adults, requiring long-term or indefinite anticoagulation due to high rates of recurrence. Anticoagulation use in menstruating individuals has been associated with increased rates of abnormal uterine bleeding. Yet, there is some reluctance amongst health care providers to prescribe hormonal contraception in these circumstances due to increased risk of VTE, particularly with estrogen-containing methods. 2024 guidelines stratify risk based on: 1) current or history of VTE receiving therapeutic dosing of anticoagulants, 2) history of VTE receiving prophylactic dosing of anticoagulants without or with higher risk of recurrent VTE, and 3) history of VTE not receiving prophylactic dosing of anticoagulants. Though combination hormonal contraceptives (CHCs) do not appear to be associated with increased risk of recurrent VTE in those receiving anticoagulation therapy, CHCs are considered to have unacceptable risk in those with a high risk of recurrent VTE. Vascular malformations such as AIVC result in venous stasis and an increased risk of VTE with CHC use. In contrast, the menstrual and contraceptive benefits of progestin-only pills (POPs), the etonorgestrel implant, and the 52-mg levonorgestrel-releasing IUD (LnGIUD) usually outweigh the risk of recurrent VTE. A POP was deemed the most favorable option when prioritizing management of heavy bleeding in our patient given the possibility of breakthrough bleeding after initiation of LnGIUD, and the risk of irregular menstrual bleeding with the etonogestrel implant. Our patient chose the drospirenone 4mg contraceptive pill which may provide a more favorable bleeding profile with significantly lower rates of unscheduled bleeding compared to traditional POPs.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 252-253"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"18. Bilateral Borderline Ovarian Tumors in a 15-Year-Old: A Rare Pediatric Case","authors":"Jennifer Silk,&nbsp;Katelyn Day,&nbsp;Laura Stafman","doi":"10.1016/j.jpag.2025.01.051","DOIUrl":"10.1016/j.jpag.2025.01.051","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian malignancy in pediatrics, with germ cell tumors being most common, is reported in 3–8% of patients. Borderline tumors, a type of tumor with low malignant potential showing cytologic traits of malignancy but lacking clear invasive growth, occur at even lower rates with no consistent statistical data reported. Pediatric bilateral borderline ovarian tumors (BOTs) have not been well described in the literature beyond case reports.</div></div><div><h3>Case</h3><div>A 15-year-old female presented to her pediatrician for a routine annual exam which revealed abdominal distention on physical exam. This prompted an abdominal x-ray and CT abdomen/pelvis which identified a 23 × 17.5 × 10.3cm cystic mass stemming from the left ovary. She initially did not report any complaints, but upon reflection, she stated that she felt distended one month prior and reported a ten-pound weight gain, fatigue, urinary frequency, light-headedness, and discomfort when stooling over the last two months. She underwent menarche at age 12 and denied any significant past medical or surgical history. She was referred to pediatric surgery for further evaluation. Tumor markers were significant for a slightly elevated CA125 (87) and inhibin-A just above normal limits (106). AFP, bHCG, LDH, and inhibin B were within normal limits. Her pelvic ultrasound noted a normal uterus, no free fluid, and a large multicystic and solid mass arising from the pelvis to the level of the liver. Due to the size of the mass, her ovaries were difficult to specifically delineate. The patient subsequently underwent an exploratory laparotomy that unexpectedly revealed masses on both ovaries, with the right mass appearing benign in the operating room and the left ovarian mass with concerning solid components and increased vascularity. Pelvic washings were obtained followed by ovarian-sparing excision of bilateral ovarian masses. Pathologic specimens were reviewed at the primary institution and sent for secondary review at an institution that specializes in pediatric ovarian pathology. The patient's pelvic washings were negative. The final diagnoses of the left (208.2g 18.5 × 14.8 × 3.2cm) and right (365 g 9.6 × 9.0 × 7.2cm) ovarian masses were proliferative serous BOTs.</div></div><div><h3>Comments</h3><div>This is an example of an extremely rare clinical scenario of bilateral serous BOTs in a pediatric patient. The case demonstrates the importance of an extensive preoperative workup for an abdominopelvic mass including imaging and laboratory assessment, collaboration of teams in the operating room and postoperatively, removal of masses without spillage in the abdominal cavity, and the significance of fertility preservation with ovarian-sparing mass excisions.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 238"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"39. Extended Use of the Etonogestrel Implant in AYA","authors":"Areej Hassan ,&nbsp;Morgan Ryan ,&nbsp;Sarah Golub ,&nbsp;MIchelle Escovedo ,&nbsp;Sofya Maslyanskaya ,&nbsp;Sarah Pitts ,&nbsp;Amy DiVasta ,&nbsp;Carly Milliren ,&nbsp;Gabriela Vargas","doi":"10.1016/j.jpag.2025.01.072","DOIUrl":"10.1016/j.jpag.2025.01.072","url":null,"abstract":"<div><h3>Background</h3><div>Although the etonogestrel implant is FDA approved for 3 years, recent data demonstrate efficacy up to 5 years. Evidence supporting extended use is limited in adolescents and young adults (AYA), especially those with higher BMI. We report on the AYA experience of extended implant use.</div></div><div><h3>Methods</h3><div>This secondary data analysis used prospectively collected QI data of all implant insertions with ≥1 follow-up visit from September 2012 to December 2023 across 4 U.S. adolescent medicine practices. Baseline demographic and clinical characteristics were assessed. We used Chi-Square and Fisher's Exact tests to compare clinical characteristics between participants with device removal before 3 y, 3-4 y, and &gt;4 y. Univariable logistic regression was utilized to assess for factors associated with extended use. Kaplan Meier curves estimated continuation rates and Cox proportional-hazards modeling examined the risk of implant discontinuation accounting for site using a robust sandwich estimator</div></div><div><h3>Results</h3><div>We included 1317 AYA (mean age 18.6 y (SD 2.5)) in our analysis. Patients primarily identified as Hispanic/Latinx (36.4%), Black/African American (21.3%), or White (21.1%). Based on age-appropriate classifications, most participants were normal weighted (44%) at time of insertion; 15.4% were overweight, 27.9% obese. Of the 807 implant removals, unsatisfactory bleeding (45.4%) and weight concerns (11.9%) were the most frequent reasons for removal. One-fifth (20%) of removals (n=200) occurred 3-4 y after insertion, and 8% (n=67) &gt;4 y. Factors reported at removal that were significantly associated with shorter use of implant (≤3 y vs &gt;3 y) included perceived unsatisfactory uterine bleeding (OR 3.94, 95% CI 2.77 - 5.59, p&lt;.05), weight concerns (OR 14.17, 95% CI 4.44 - 45.21 p&lt; .05), and mental health change (OR 3.94, 95% CI 1.78 – 8.73 p&lt;.05). There were no pregnancies noted with extended implant use. The 1-year continuation rate was 78%, dropping to 56%, 36%, 12% and 2% at years 2, 3, 4, and 5. Our survival analysis (Fig) demonstrated a significant difference between BMI categories and time to discontinuation. Obese patients had the lowest discontinuation rates for the study period compared to normal weighted patients (hazard ratio adjusted for site 0.945, 95% CI 0.921-0.970, P&lt;.0001)</div></div><div><h3>Conclusions</h3><div>Over a quarter of participants kept their implant &gt;3 years. AYA are more likely to undergo early device removal for concerns related to mental health change, unsatisfactory bleeding, and weight. AYA with obesity at time of insertion may keep their device longer. No pregnancies were observed. Clinicians should engage in shared decision making with patients regarding extended use of the implant.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 248"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"41. Ferritin Screening in Female High School Student-Athletes Identifies Many who have Iron Deficiency","authors":"Alexis James ,&nbsp;Steven Fein ,&nbsp;Dayne Alonso","doi":"10.1016/j.jpag.2025.01.074","DOIUrl":"10.1016/j.jpag.2025.01.074","url":null,"abstract":"<div><h3>Background</h3><div>Iron deficiency (ID) is highly prevalent among teenage females. It has been associated with impaired concentration and fatigue, and it may affect both academic and athletic performance. In this study, we sought to quantify the prevalence of ID in teenage female student-athletes, and to correlate ID with fatigue, athletic performance, and academic performance.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of female student-athletes in a suburban high school. After IRB approval, students were approached for study enrollment during a sports team practice session. After obtaining parental consent, students had ferritin testing and assessments of fatigue, athletic performance, and academic performance. Iron deficiency was defined as ferritin &lt; 30 ng/mL.</div></div><div><h3>Results</h3><div>Low ferritin (&lt; 30 ng/mL) was found in 8/23 (35%) female student-athletes. Only two had prior awareness that they had iron deficiency. Fatigue, athletic performance, and academic performance will be reported in a 2025 NASPAG presentation.</div></div><div><h3>Conclusions</h3><div>In this cross-sectional study of female student-athletes, we found that iron deficiency is common. Our finding, 35% with low ferritin, is consistent with the prevalence of iron deficiency among teenage females in a large NHANES-based cross-sectional study by Weyand, et al. Most of the students found to have ID in our study had no prior knowledge that they had iron deficiency. This study highlights the importance of iron deficiency screening in female student-athletes. More student-athlete screening will be reported in a 2025 NASPAG presentation.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 249"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"52. Hysteroscopic metroplasty for use of intrauterine devices in adolescents and young adults","authors":"Erin Isaacson,&nbsp;Melina Dendrinos,&nbsp;John Randolph","doi":"10.1016/j.jpag.2025.01.085","DOIUrl":"10.1016/j.jpag.2025.01.085","url":null,"abstract":"<div><h3>Background</h3><div>There is no published literature on the use of hysteroscopic metroplasty in an adolescent or young adult (AYA) population, nor for the indication of desired intrauterine device (IUD) usage. We aimed to describe the usage of this procedure, which has historically been performed for reproductive concerns, in AYA with uterine septa who desired IUD insertion for dysmenorrhea, contraception, and heavy menstrual bleeding (HMB).</div></div><div><h3>Case</h3><div>All patients presented were diagnosed with a uterine septum when evaluating for a possible malpositioned IUD, and had either trialed systemic hormone management or had medical restrictions on hormonal treatment options. All previously placed IUDs were removed prior to surgical management. All metroplasties were performed using a bipolar Twizzle Tip electrode to incise the septum and all patients had uncomplicated placement of a 52-mcg IUD at time of metroplasty. A 15-year-old G0 with dysmenorrhea desired a hormonal IUD after failing combined hormonal methods. Her complete uterine septum was diagnosed via ultrasound after a string check raised concerns for a low-lying IUD. After counseling, she desired surgical removal of her septum to be eligible for repeat placement. After uncomplicated septum resection and IUD placement, she was seen for a one month post-operative visit without any reported irregular bleeding or pelvic pain. A 17-year-old G0 presented for HMB and dysmenorrhea. Her medical history included juvenile idiopathic arthritis and migraines with aura. After IUD placement, she underwent abdominal imaging for a weight loss work-up that noted a malpositioned IUD and uterine septum. After repeat counseling on available methods, she maintained that an IUD was best for her menstrual management. She underwent an uncomplicated septum resection and IUD placement, and was seen for follow-up at two months without further menstrual complaints. A 25-year-old G1P0010 with dysmenorrhea and HMB, with failure of two hormonal methods, had worsening dysmenorrhea after IUD placement. Pelvic imaging revealed a complete uterine septum with divergence of the lower segment into two separate cervixes. She underwent uncomplicated resection and IUD placement, as well as a laparoscopy to evaluate her dysmenorrhea. She was seen two months post-operatively with a significant improvement in menstrual symptoms.</div></div><div><h3>Comments</h3><div>This case series highlights the importance of metroplasty as a consideration for patients for whom an IUD is the preferential or only treatment option for a variety of gynecologic indications, especially for those unable to use other hormonal therapies secondary to side effects or co-existing conditions.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 254"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"51. Hypervascularized solid ovarian tumor, what a good surprise: ovarian sclerosing stromal tumor","authors":"Magdalena Castro ,&nbsp;Carolina Pastene ,&nbsp;Mónica Muñoz ,&nbsp;Constanza ralph ,&nbsp;Maria Alejandra Delgado ,&nbsp;Paloma Gomez ,&nbsp;Isabel Fuentealba","doi":"10.1016/j.jpag.2025.01.084","DOIUrl":"10.1016/j.jpag.2025.01.084","url":null,"abstract":"<div><h3>Background</h3><div>Sclerosing stromal tumor (SST) is a rare benign sex cord-stromal tumor (SCST) of the ovary, accounting for less than 5% of all ovarian SCST cases. We aim to present a case where a solid ovarian tumor, initially suspected as malignant due to imaging findings, was ultimately diagnosed as a benign SST in a postmenarcheal adolescent.</div></div><div><h3>Case</h3><div>A 14-year-old girl with a history of medulloblastoma, treated with chemotherapy and radiotherapy, was under endocrine care for severe short stature. A pelvic ultrasound revealed a solid, homogeneous, hypervascularized tumor in the left ovary (18 cc), without cystic areas or calcifications. CT confirmed a well-defined, hyperenhancing mass (27 × 49 × 32 mm) in the left adnexa, displacing nearby structures. Tumor markers were negative: LDH 285 U/L, BhCG &lt; 2.4 mIU/mL, Alpha Feto protein &lt; 2 ng/mL, Anti-Mullerian hormone 0.77 ng/mL, Ca 125 32.8 U/mL, Ca 19-9 20.7 U/mL, CEA 2.7 ng/mL. Laparoscopic left adnexectomy was performed, and histopathology confirmed an ovarian SST. The patient's recovery was favorable, and no malignancy was detected. This case was reviewed and approved by the Ethics Committee of Hospital Dr. Luis Calvo Mackenna.</div></div><div><h3>Comments</h3><div>Despite the low incidence of SST, particularly in young girls, its clinical and imaging findings can mimic malignancy. This case underscores the importance of imaging and histopathology for diagnosis. MRI may help identify benign features and avoid overtreatment, preserving fertility. The benign nature of the tumor provided reassurance to the patient and her family. Financial Disclosure: The authors have no financial relationships relevant to this case to disclose.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 253"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}