Evaluation of cases of puberty menorrhagia requiring in-patient care

Abstract

Background: Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional or material quality of life. Puberty menorrhagia is excessive bleeding occurring between menarche and 19 years. Abnormal bleeding amounts to 50% of gynaecological visits in adolescent girls. The leading cause of puberty menorrhagia is hypothalamic pituitary, ovarian axis immaturity followed by bleeding disorders, endocrine disorders. Excessive blood loss leading to anaemia has a negative impact over the development and quality of life of the adolescent, requiring immediate attention to these cases. The objective was to evaluate the incidence, etiology and management of puberty menorrhagia requiring in-patient care.Methods: A retrospective observational study was done on adolescents admitted for management of puberty menorrhagia in Kempegowda Institute of Medical Sciences over a period lasting from January 2017 to October 2021 from hospital records.Results: Amongst the 35 admitted, 42% belonged to the age group 10-14 years. 62.8% presented with symptoms lasting less than 6 months. 20% presented with haemoglobin less than 4 gm, 51.4% with haemoglobin between 4 gm to 6 gm, 28.6% with 6 gm to 8 gm. 57.2% patients had anovulatory cycles, 25.7% were PCOS, 11.4% had hypothyroidism and 5.7% had fibroid uterus. 42% ultrasonographies showed PCOS, 5.7% had fibroid uterus. The approach to managing these patients were with a combination of hormone therapy, hematinics, blood transfusion and anti fibrinolytics like tranexemic acid. 20% received tranexemic acid and hematinics. 31.42% received blood, hematinics and tranexemic acid, 11.42% received hematinics, tranexemic acid and thyroxine, 17.14% received blood, hematinics, tranexemic acid and progesterone, 8.57% received hematinics, tranexemic acid and COCs, 11.42% received hematinics, tranexemic acid and progesterone.Conclusions: In conclusion, the leading cause of puberty menorrhagia was anovulatory cycles, followed by PCOS and then by endocrine dysfunction. Medical management was successful in all cases.