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Question: Menorrhagia

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You are seeing a 13 year old girl with heavy prolonged menses x 10 days who appears pale to her parents. She had menarche at age 11, and has had heavy irregular menses since then. She actually feels that her menses is slowing down and she is currently using 1-2 pads per day. She has never had any other bleeding. Her HR is 90, and BP 100/50. Her hemoglobin is 9 and her MCV is 65.

What is the best management?

pemsou5_wp • June 12, 2018

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  1. Kelly June 12, 2018 - 4:10 pm Reply

    B. Dysfunctional uterine bleeding in adolescents is most commonly due to anovulatory cycles, and menstrual irregularity is common in the first several years after menarche. Mild abnormal bleeding (hemoglobin > 10-12) can be managed with iron as indicated, hormone therapy if desired, and follow up in 3-6 months. If hemoglobin is between 10-12, iron and hormone therapy should be given. Moderate bleeding (hemoglobin > 10) with continued active bleeding can be treated with oral contraceptives 1 pill every 6-8 hours (antiemetics may be needed) initially to stop bleeding with rapid tapering to one per day, iron, and close follow-up. Severe bleeding (hemoglobin < 10) should be managed with oral contraceptives 1 pill every 4-6 hours to stop bleeding, iron, and close follow-up. Patients with hemodynamic instability, severe symptoms (eg dizziness, fainting), hemoglobin < 7, or significant active bleeding, should be admitted, treated with IV estrogen to stop the bleeding, and may require transfusion. Patients should also be worked up for Von Willebrand’s disease.

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