Puberty Menorrhagia
What is it?
Puberty menorrhagia is a term used for adolescent girls experiencing heavy , irregular bleeding during the menstrual cycle. Excessive bleeding in amount or duration between menarche and 19 years of age is termed as Puberty Menorrhagia.
Menarche is a hallmark event in the life of most adolescent girls. It marks the transition from childhood to puberty. Although mechanisms triggering puberty and menarche remain uncertain, they are dependent on genetics, nutrition, body weight and maturation of the hypothalamic pituitary- ovarian axis. The complete maturation of the axis may take up to 2 years. During this time, it is common for adolescents to present with complaints of menstrual irregularities.
How much is normal menstrual blood loss?
- Normal menstrual blood loss:pads/tampon changes at ≥3 hour intervals, seldom overnight and fewer than 21 pads/tampons per cycle
- Excessive menstrual flow is defined as any of the following
- Menstrual cycles are often irregular and anovulatory in the first few years after menarche. The time to establish regular ovulatory cycles increases with increasing age of menarche
- Anovulatory uterine bleeding is excessive noncyclic uterine bleeding related to immaturity of the hypothalamic-pituitary-ovarian axis (in the absence of structural uterine lesions or systemic disease)
● >7 days duration or >80 mL
● necessitating changing a super pad/tampon more than every 2 hours
● causing symptomatic anaemia
● causing lifestyle disturbance
What are the causes of Puberty Menorrhagia?
In 80% of cases puberty menorrhagia is caused by anovulatory cycles.
- Pregnancy: miscarriage, ectopic pregnancy, gestational trophoblastic disease
- Endocrine: anovulatory, thyroid dysfunction, polycystic ovarian syndrome (PCOS)
- Haematological: von Willebrand Disease, platelet function disorder, thrombocytopenia, other bleeding disorder
- Medication: hormonal contraception, anticoagulants
- Other: trauma, infection, malignancy, structural causes (uncommon in adolescence), gastrointestinal bleeding
When should you meet us?
When because of heavy menses the patient feels weakness, anemia, low blood pressure, increased heart beat, pain in abdomen. When day to day activity is hampered or hemoglobin level has gone down significantly then it is time to meet your gynecologist.
Treatment options?
The treatment can vary according to the severity of the condition. In mild cases non hormonal treatment like NSAIDs, tranexamic acid during menses and reassurance is helpful.
In moderate cases: Oral Hormonal medication along with NSAIDs/Tranexamic Acid should be used.Tranexamic acid during menses.
Hormonal Therapy
- Combination estrogen-progesterone oral contraceptive pills
- Oral progesterone-only hormone therapy
- High dose norethisterone
● In severe cases:IV Access
● Fluid bolus & Resuscitation
● Tranexamic acid
● Hormonal Therapy
Iron infusion as required or PRBC if haemodynamic instability despite fluid resuscitation Inpatient observation would be needed.