MC cause of Puberty' Menorrhagia:
Ans-A (Anovulation) [Ref Shaw 14th/ 271; Novak 14th/447- 449 ; COGDT 10th/ 557)Puberty Menorrhagia# Puberty'menorrhagia is a threshold of bleeding of adolescence caused by:* Excess or unopposed estrogen & absence of progesterone in the anovulatory cycles- most common.* Coagulation disorders (20%)# Menorrhagia may be noticed from the very start of menarche, but often, the initial few periods are normal"Puberty menorrhagia is excessive cyclical regular bleeding occurring in adolescents. Most common cause of puberty menorrhagia is anovulation which results in excess of estrogen or unopposed estrogen in absence of progesterone, and the most common cause is- Bleeding disorders- blood dyscrasias and coagulation disorders"- Shaw 14th/ 271Other Cause of Abnormal Bleeding in Adolescents. Novak 14th /447- 449# Pregnancy-related bleeding# Sexually transmitted- Infections - particularly chlamydia# Sexual abuse# Hepatic dysfunction# Hyperprolactinemia (it can cause either amenorrhea or irregular bleeding)# PCOS- It can occur during adolescence also# Hypothyroidism# Anatomical cause - Partially obstructive genetic anomalies.Table: Shaw 14th/271DUB is of two type1. Anovulatory (80%)2. Ovulatory (20%)Anovulatory (80%)1. Threshold bleeding of puberty menorrhagia2. Metropathia hemorrhagia'-'/ cystic glandular hyperplasia3. Premenopausal DUB (Atrophy of endometrium).Ovulatory (20%)1. Irregular ripening2. Irregular shedding3. IUCD insertion4. Following the sterilization operation.Anovulatory Bleeding Treatment Novak 14th /451-54, COGDT 10th/557Mild bleedingHematinicsReassuranceHormone therapy = lowDose OCFS or cyclical progesterone therapy (Medroxyprogesterone acetate 5- 10mg/day for 10-13 days).Moderate bleedingCombination monophask OC P every 6 hrs. for 4-7 days and then stop | followed byWithdrawl bleeding| followed byLow dose OCP for 3 to 6 by cycles Acute severe bleedingEmergency management:Admit the patientStabilize the vitalsConjugated estrogen 25 -40mg LV every 6 hrs or 2.5mg oral estrogen every 6hrs.Once bleeding stops medroxy progesterone l0mg for 10 days if above regime is not effectively assessed the patient for any local cause. USG should be done to rule out fibroid/endometrial hyperplasia or clots.It intrauterine clots are detected D & C should be done.
Anovulation
Malignancy
Endometriosis
Bleeding disorder