Perimenarchal Menorrhagia: Evaluation and Management
Article Outline
A pale 13-year-old girl presented to a local Emergency Department with excessive vaginal bleeding and fainting. Menarche occurred 1 month before presentation. Her second period started 17 days preceding hospital arrival. She was nonobese with a hemoglobin of 5.9 g/dL but with normal platelets, white count, coagulation studies, Factor VIII antigen, Ristocetin cofactor assay, thyroid-stimulating hormone, prolactin, and a negative pregnancy test. She received a total of 12 units of packed red blood cells, 25 mg Premarin intravenously ×1, and 100 mg progesterone intramuscularly ×1. Pelvic ultrasound demonstrated a 16-mm endometrium. Once hemodynamically stable, she was discharged home with iron supplements and Lo/Ovral (ethinyl estradiol and norgestrel) (Wyeth Pharmaceuticals, Madison, New Jersey), 3 pills daily for 8 weeks.
She was subsequently referred to our clinic. Despite hormonal treatment, she continued to have heavy menses. Therefore, we proceeded with hysteroscopy to further evaluate the thickened endometrial lining. Hysteroscopy revealed a 1-cm sessile polyp (Figure), which was removed with sharp curettage. The pathology report confirmed a benign polyp. Menorrhagia resolved after polypectomy, with no recurrence of over the last 4 years of follow-up.
Figure.
Endometrial polyp (1 cm) seen in the posterior wall at the junction of the upper endocervical canal and lower uterine segment.
Abnormal uterine bleeding is a frequent complaint by adolescent girls. Common causes of abnormal uterine bleeding in this age group are anovulation due to an immature hypothalamic-pituitary-ovarian axis and bleeding diathesis. The differential also includes pregnancy, thyroid disease, chronic medical disease, use of exogenous hormones, sexual assault or trauma, tumors, vulvar disease, intrauterine anomalies, and mullerian anomalies. It is thought that endometrial polyps are rare in this age group, with only 2 prior reports dating back to 2002.1, 2 Endometrial polyp as a source of abnormal uterine bleeding in adolescence is underreported and should be considered in the differential in this age group.
References
PII: S0022-3476(09)00659-3
doi:10.1016/j.jpeds.2009.07.026
© 2010 Published by Elsevier Inc.
