Because puberty is an immature stage and the central system’s positive feedback mechanism to estrogen is not yet mature, sometimes follicles do not ovulate even though they are mature and anovulatory dysfunctional uterine bleeding can easily occur. Within 1 year of menarche, 80% of menstrual periods are anovulatory. Within 2 to 4 years after menarche, 30% to 55% of menstrual cycles are anovulatory, and at 5 years after menarche, less than 20% of menstrual cycles may still be anovulatory and 1/3 of cycles may be luteal deficient. Anovulatory dysfunctional uterine bleeding occurs easily, but we know that dysfunctional uterine bleeding is a diagnosis of exclusion, so what tests do we need to do to establish the diagnosis? Should chromosomal testing be done? No, chromosomal examination is mainly a means to check whether there are congenital abnormalities in the ovaries and ovaries. Patients with dysfunctional uterine bleeding must have estrogen secreted by the ovaries, so we do not need to consider chromosomal examination. Should sex hormone tests be done? The purpose of the various tests implemented clinically is to provide a valuable basis for making clinical decisions for diagnosis and treatment. However, sex hormone tests are mainly used for the diagnosis of amenorrhea. When estradiol (E2) is low, follicle stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) are measured to diagnose the cause of amenorrhea, whether it is ovarian amenorrhea (elevated FSH and LH) or hypothalamic-pituitary amenorrhea (elevated FSH and LH). -The diagnosis of the cause of amenorrhea is made in order to determine the prognosis and the treatment plan. If there is a clinical manifestation of hyperandrogenism, blood testosterone (T) levels can be measured to determine whether PCOS is present or to rule out other diseases causing hyperandrogenemia such as adrenal disease or androgen-secreting tumors. Not all patients with menstrual disorders require measurement of the 6 sex hormones (E2, progesterone (P), LH, FSH, PRL, T). The vast majority of patients with dysfunctional uterine bleeding have follicular development, but no ovulation, so there is only a relative lack of estrogen rather than an absolute lack of estrogen. In patients with dysfunctional uterine bleeding, the results of the 6 sex hormone tests are usually in the normal range except for low progesterone, and the other 5 are often in the normal range. Low progesterone is expected and is known without measurement. In this analysis, the measurement of sex hormone 6 in patients who are basically diagnosed as having gonorrhea cannot provide more valuable information for clinical diagnosis and treatment, but causes unnecessary costs, so it should not be a routine test for gonorrhea. Should pelvic ultrasound be done? The use of pelvic ultrasound in obstetrics and gynecology is an epoch-making advance in the diagnosis of obstetrical and gynecological diseases. It allows non-invasive visualization of the location, size and internal texture of organs and masses in the pelvic cavity, and is the only non-invasive way to understand the situation in the uterine cavity. The purpose of pelvic ultrasonography in patients with uterine bleeding is to rule out organic diseases of the pelvis. This test helps to detect occupational lesions of the uterus (e.g. uterine malformations, fibroids, ovarian tumors, etc.) and pregnancy-related problems, but often fails to help with cavity and endometrial pathologies that are more closely related to bleeding. This is because when bleeding occurs, there will be blood or clots in the uterine cavity, and because the contrast in density of the interface between the blood or clots and the uterus will reflect strong echogenic clusters or irregular echogenicity on the ultrasound image, it is very easy to misdiagnose organic lesions in the uterine cavity and thus make the wrong and overly aggressive decision to perform an immediate curettage. Ultimately, however, we must check the pelvic ultrasound, but we must be cautious about whether to scrape the uterus. Should we rule out pregnancy? Many adolescent women are already sexually active, but they don’t say so easily, and if we take for granted that they should not be sexually active, we will miss and misdiagnose most abnormal uterine bleeding. So, whether the patient denies or admits to having sex, we must rule out pregnancy, so urine or blood HCG is the recommended test. How easy is it to check for hematological disorders? For example, age of menarche, cycle, period, last menstruation; is there a prolonged menstrual cycle followed by vaginal bleeding or is the menstruation extremely irregular from the beginning. Are there any certain triggers: stress from midterm and entrance exams? Changes in diet, sleep and other habits? Major family changes? Any excessive exercise, etc.? Is it accompanied by generalized purpura, gum bleeding, etc.? When the body is affected by various internal or external factors, such as mental tension, fear, sadness, overwork, nutritional disorders, anemia, metabolic disorders, chronic diseases, sudden changes in the environment and climate, eating disorders, excessive exercise, alcoholism and other drugs, it can cause hypothalamic-pituitary-ovarian axis function through the cerebral cortex and central nervous system. The hypothalamic-pituitary-ovarian axis can be abnormally regulated or target cell effects can cause menstrual disorders. Physical examination is also important! Adolescent gynecological bleeding is a common disease in gynecological clinics. Since most of them are unmarried and have no sexual history, it is usually not convenient to do pelvic internal examination, and often endocrine drugs are used directly to stop bleeding. For those patients with long-term drenching bleeding that cannot be completely stopped by repeated progesterone withdrawal, vaginal examination should be considered after excluding hematologic disorders and not just appeasement, because there is a possibility of cervical or vaginal abnormalities or even malignant tumors. Usually tumors of the cervix or vagina in unmarried women are often not easily detected by anal examination and transabdominal ultrasound. What is the most important test for abnormal uterine bleeding in obstructed ovulation during puberty? Routine blood count is the most important. Its mainity is reflected in three points: the platelets should be looked at carefully for any thrombocytopenia; the blood HGB should be looked at carefully for reference on how to treat; and the white blood cells and neutrophils should be looked at carefully for possible infection caused by prolonged bleeding! Principles of treatment to stop bleeding in uterine bleeding include both surgical and pharmacological hemostasis. Surgical (curettage) methods should be used to stop the bleeding and obtain a pathological diagnosis when the organic cause of the uterine cavity needs to be excluded. However, scraping is basically not needed for adolescent uterine bleeding because most patients are not sexually active; the possibility of endometrial lesions in patients with adolescent uterine bleeding is negligible. Therefore, stopping the hemorrhage with medication is the best treatment option. There are 3 commonly used endocrine medications to stop bleeding: progestin endometrial shedding method, estrogen endometrial growth method and endometrial atrophy method.