A Case Review: Pubertal Menorrhagia


A 14 year girl complained of increased pv bleeding in her 2nd menstrual cycle,associated with severe dysmenorrhoea.Her first menstrual cycle was normal.There was no any significant medical,family,personal and treatment history.

O\E: she looked pale.

Her vitals were stable.

P\A- soft,no mass felt


Hb% -low

coagulation profile- within normal limit

USG abdomen & pelvis- no any abnormality detected




DEFINITION– Puberty menorrhagia is a threshold bleeding of adolescense caused by excess or unopposed oestrogen and absence of progesterone in the anovulatory cycle.It occurs in the form of excessive bleeding or normal but continuous bleeding lasting many days.

complication– anaemia,emotional stress



-Blood= Hb%-usually low

-Coagulation profile- BT,CT,Platelet count to rule out any bleeding disorder

-Thyroid profile-to rule out hypothyroidism that can lead to menorrhagia

-USG of pelvis to rule out pelvic pathology


Usually the mangaement is simple.If anaemia present,then it is corrected by blood transfusion,rest. The emotional aspect is corrected by adequate explanation, reassurance and psychological support.

If the above measures fails, then potent progesterone like medroxy progesterone acetate or noretisterone 5mg thrice a day is given till bleeding stops, which generally takes 3-7 days. Following withdrawal bleeding the same preparation 5mg is started on the day 5 and continued for 20 days. The condition usually becomes normal following 2-3 courses and the normal periods resume.

If the above progesterone therapy fails to control bleeding, conjugated estrogen 20-40mg iv is given every 6-8hrs. As the bleeding stops, we replace it with combined oral pills containing 50micro gm of oestrogen,

If the patient is unresponsive to the estrogen therapy as well, examination under anaesthesia[EUA] and dilatation and curettage is done and the material is sent for histopathological examination to rule out pelvic pathology. But while performing D&C, we should keep pregnancy complication in mind.

If the menorrhagia is secondary to ITP, hypothyroidism, we have to treat the underlying cause as well.

Case Collected and workedout By Dr. Anjali Subedi

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