Treatment Modalities in Adolescents Who Present With Heavy Menstrual Bleeding Tasneem Alaqzam, MD, Veronica Flood, MD, Seema Menon, MD Medical College of Wisconsin, Division of Adolescent Medicine

S106 Poster Abstracts / 60 (2017) S83eS126 messages relevant to undergraduates can improve their sexual consent understanding and intentions to obtain sexual consent before engaging in sex with a partner. Sources of Support: The Office of Student Affairs at the university where the campaign was implemented provided financial support for the campaign. 196. WILLINGNESS TO PARTICIPATE IN A HYPOTHETICAL MICROBICIDE CLINICAL TRIAL: CHANGES IN ADOLESCENT-PARENT DISCORDANCE OVER TIME Ariel de Roche, BS 1, Christine Mauro, PhD 2, Marina Catallozzi, MD 1, Jane Chang, MD 3, Carmen Radecki Breitkopf, PhD 4, Susan L. Rosenthal, PhD 1. 1 Columbia University Medical Center; 2Columbia University, Mailman School of Public Health; 3Weill Cornell Medical College; 4 Mayo Clinic. Purpose: Changes in cognitive and psycho-social development during adolescence can lead to increased conflict with parents regarding autonomy and decision-making. These changes and resulting potential for disagreement could be evident in decisionmaking about clinical trial participation if it requires adolescent assent and parent permission/consent. We sought to describe patterns of adolescent-parent concordance/discordance regarding willingness to participate (WTP) in a hypothetical clinical trial over one year. Methods: Adolescent (14-17 years) and parent dyads completed a questionnaire assessing WTP in a hypothetical microbicide safety study at baseline and one year later. WTP was rated on a 6-point Likert scale and dichotomized into being likely to participate or not regardless of the strength of the opinion. The dyads were characterized as: (1) concordant in being unlikely to participate; (2) concordant in being likely to participate; (3) discordant, only the adolescent being likely to participate; and (4) discordant, only the parent being likely to have their adolescent participate. Results: Of the 298 adolescent-parent dyads, the adolescents were 62% female, 53% 16-17 years old; the parents were 92% female and 71% Hispanic. With regards to baseline WTP, overall 61% (n ¼ 181) of adolescents and 52% (n ¼ 155) of parents were likely to participate and 44% of dyads were discordant, regardless of direction. Sixty four (21%) were concordant in being unlikely; 102 (34%) were concordant in being likely, 79 (27%) were discordant with only the adolescent WTP, and 53 (18%) were discordant with only the parent being WTP. At the one year follow-up, 246 dyads (83%) returned of which 56% (n ¼ 136) of adolescents and 57% (n ¼ 139) of parents agreed to participate. Overall, 30% were discordant, regardless of direction. At follow-up, 141 (57%) of dyads remained the same with regards to the category of concordance/discordance. A small number (n ¼ 6, 2%) stayed concordant but both individuals changed their likelihood of participating. Eight (3%) remained discordant, but both participants switched the direction of their likelihood of participating. Thirty (12%) were concordant at baseline, and one member of the dyad switched the direction of his/her answer at follow-up. Sixty-one (25%) were discordant at baseline and were concordant at follow-up, of which 36 switched to agree with the adolescents’ initial answer. There were no adolescent age differences between dyads whose concordance changed or stayed the same, suggesting that age alone was not explanatory. Conclusions: Although more dyads were in agreement, discordance was common at baseline. Slightly over half of dyads’ likelihood of participation and patterns of concordance/discordance remained the same at the one year follow-up. There were a variety of patterns of change in concordance/discordance observed, with more dyads becoming concordant than becoming discordant. Future research should determine if there are specific experiences in an adolescent’s developmental trajectory that are associated with each pattern. This information could be used to support parents and adolescents to negotiate clinical trial participation and decision-making within adolescents’ emerging autonomy. Sources of Support: Not applicable. 197. TREATMENT MODALITIES IN ADOLESCENTS WHO PRESENT WITH HEAVY MENSTRUAL BLEEDING TASNEEM ALAQZAM, MD, VERONICA FLOOD, MD, SEEMA MENON, MD MEDICAL COLLEGE OF WISCONSIN, DIVISION OF ADOLESCENT MEDICINE Tasneem Saleh Alaqzam, MD, Veronica H. Flood, MD, SeemaMenon, MD. Medical College of Wisconsin. Purpose: Heavy menstrual bleeding (HMB) is reported to affect between 10%-40% of adolescents worldwide. Adolescents with HMB experience significant bleeding which requires hospitalization and blood transfusion. There is no consensus regarding the best treatment for adolescents with HMB. Objectives of this study are to assess the most effective option to achieve menstrual stability in the setting of underlying Bleeding Disorders (BD). Additionally, this study sought to determine the relationship of BD to Iron Deficiency Anemia (IDA). Methods: A retrospective chart review was conducted on patients with HMB presenting to a multidisciplinary menorrhagia clinic at a tertiary pediatric facility, between 11/2012 and 04/2015. This study included 10-21 year old females seen for a HMB consultation. Exclusion criteria were: >age 21, RBC disorders, and cancer. Study variables included age of menarche, reported bleeding diathesis, baseline hemoglobin, lowest recorded hemoglobin, presence of IDA, requirement for blood transfusion, hormonal treatment methods, achievement of menstrual suppression. Descriptive statistics and t-test were used in analysis. Results: 76 subjects with HMB were identified with a mean age of 14.4 years (+/- 2.18). A BD was found in 34 (46%) of the 73 patients; 26 were diagnosed with von Willebrand Disease (VWD), 8 were diagnosed with platelet function defects (PFD). Hypothalamic immaturity, idiopathic thrombocytopenic purpura (ITP), and unknown cause accounted for HMB in 42 subjects. There was no difference in hemoglobin between subjects with and without VWD (hemoglobin 11.9 vs 11.0, p¼NS), PFD (12.8 vs 11.0, p¼NS), or ITP (10.7 vs 11.4, p¼NS). When all subjects with BD were combined, there was still no significant difference in mean hemoglobin (12.0 vs 10.6, p¼NS). Admission with transfusion occur in 20% (n¼15) subjects; 12(80%); had no BD and 3(20%) had VWD. All subjects were screened for IDA. A mean hemoglobin of 9.0 g/dl was noted for subjects with IDA, and 13.2 g/dl for subjects without IDA (p<0.001). Only 8/26 (31%) subjects with VWD and 3/8 (37%) subjects with PFD had IDA. Of the 34 subjects with BD, 25 (73%) used combined birth control pills (COC), 17 (50%) used medroxyprogesterone acetate (DMPA), 9 (26%) used LNG- IUD, 5 (15%) Poster Abstracts / 60 (2017) S83eS126 used norethindrone, and 5 (15%) used transdermal contraceptive patch. Achievement of menstrual suppression was: 89% with LNGIUD, 80% with transdermal contraceptive patch, 60% with norethindrone, 48% with COC, and 47% with DMPA. 8 subjects (24%) with BD were treated with antifibrinolytic; 100% achieved menstrual suppression. Conclusions: Given the high frequencies of BD identified in this study, suspicion should be high in adolescents with HMB. Although prevalence of HMB is high in adolescents with BD, they are less likely to present with severe anemia requiring blood transfusion. COC are commonly used for menstrual suppression; our retrospective cohort demonstrated a high failure rate. Hormonal IUDs may provide improved menstrual suppression, but larger prospective studies will be needed to confirm these findings. Further studies are needed to investigate quality of life associated with these treatment modalities. Sources of Support: Minjarez DA, Bradshaw KD. Abnormal uterine bleeding in adolescents. Obstet Gynecol Clin North Am. 2000 Mar. 27(1):63-78. 198. EXPERIENCES OF EARLY AND FORCED MARRIAGE IN CONAKRY, GUINEA: AN EXPLORATORY STUDY Yvette Efevbera, MS. Harvard T. H. Chan School of Public Health. Purpose: In Guinea, West Africa, 1 in 2 women marry before the age of 18. Marriages may be arranged by families, sometimes without the woman’s consent. These phenomena, referred to as child/early marriage and forced marriage, are believed to impact women’s well-being and health, though limited evidence exists in the African context. This exploratory study qualitatively explored perceptions of the social construct of marriage, and its relationship to health and well-being, among ever-married women in Conakry, Guinea. Methods: This study was rooted in Grounded Theory. Participants included 4 married women, recruited using purposive sampling, who consented to participate in two individual interviews. Semistructured interview guides were used, developed from results of a quantitative study on marriage and child health (Efevbera, Bhabha, Farmer, and Fink, in progress). Observation of participants’ everyday lives, and participant observation, were also conducted with consent. Interviews were recorded, transcribed, and translated, and open coding was used for analysis. Consent was obtained from participants and local leaders. Ethics approval was obtained from the Harvard Longwood Medical Area Institutional Review Board and Guinea’s Committee National D’Ethique Pour La Recherche en Sante (CNRES). This study was conducted from June to August 2016. Results: Women’s perceptions and experiences of marriage in their society varied substantially. Three women described their own age of marriage as “early,” as they married at 15, 16, 17 years respectively, and two described their marriage as “forced,” including one who married at 25 years. All participants described that women are expected to marry when they are “of age,” which varied from after puberty for one participant to after completing education for others. They consistently described that marriage is between families, not individuals. All of the women described that they felt obligated to marry for family, economic, and cultural reasons. Only one woman spoke positively overall about her S107 marriage. When asked about the influence of marriage on health, all of the women discussed the greater likelihood of complications in pregnancy, which they described may also affect the children. Two women shared painful memories of repeated physical and sexual abuse from their husbands. None of the women said they would want a daughter of theirs to get married at the age or in the way that they did. All of the women interviewed described their children as their successes, regardless of the experiences of their marriages. They related their perceptions to cultural norms and expectations: a young woman is supposed to marry and produce children. Many illustrated how their children’s lives are somehow better than their own, whether they married at a later age, or had the opportunity to complete schooling regardless of gender. Conclusions: This exploratory study of multiple, in-depth interviews with women who experienced early or forced marriages reveals that from their experiences, these marriages do affect wellbeing and health. This study also established feasibility of qualitatively exploring a culturally-sensitive topic. This is the first known study to qualitatively explore these perceptions in-depth in the context of Guinea. Sources of Support: Harvard University. 199. PREVALENCE OF CARDIOMETABOLIC ABNORMALITIES IN A CLINICAL SAMPLE OF YOUNG WOMEN WITH POLYCYSTIC OVARY SYNDROME Holly C. Gooding, MD, MPH 1, Frank Stortini, MAT 2, Patrick J. Henke, MSc 3, Amy D. DiVasta, MD 2. 1 Boston Children’s Hospital/Brigham and Women’s Hospital; 2Boston Children’s Hospital; 3Burrell College of Osteopathic Medicine. Purpose: Polycystic ovarian syndrome (PCOS) affects 6-8% of reproductive-aged women and is associated with significant cardiometabolic morbidity in adulthood, including dyslipidemia, hypertension, and diabetes. Optimal methods of identification and treatment of adolescent PCOS and its associated comorbidities are still debated, and thus are highly amenable to quality improvement via a Standardized Clinical Assessment and Management Plan (SCAMP). Using a PCOS SCAMP, we sought to elucidate which testing for metabolic abnormalities should be performed during adolescence. Methods: From June 2012 to June 2016, we screened 249 females ages 11-25 years who presented to an outpatient adolescent and young adult practice with irregular menses, hirsutism, or hyperandrogenism for SCAMP participation. Clinicians collected data on medical history, physical exam findings, and laboratory results. Diagnostic tests were ordered based upon evidence-based or consensus-based algorithms developed for the SCAMP; providers noted where they deviated from SCAMP recommendations due to clinical judgment or patient preference. Results: Forty-four patients (18%) were overweight and 96 (39%) were obese. Sixty-two percent had acne, 56% had hirsuitism, and 27% had acanthosis nigricans. Laboratory data were available for 183 patients (74% of those screened). Ten percent (n¼24) had impaired glucose tolerance (IGT), defined as a fasting plasma glucose level 100 mg/dL, a 2-hour plasma glucose level 140 mg/ dL on an oral glucose tolerance test (OGTT), or a HbA1c 5.7%. Seventy-five percent (18 of 24) of those diagnosed with IGT met criteria due to an abnormal HbA1c, while 42% (10 of 24) met criteria due to an abnormality noted on OGTT. Nine (2%) patients