management of pubertal menorrhagia

K NAVANEETHARANI UNIT OG

DYSFUNCTIONAL UTERINE BLEEDING

Management at Pubertal Age Group

• MAJOR• MAJOR

MINOR MINOR

Immature hypothalamo-pituitary axis• excess/unopposed estrogen • absent progesterone in anovulatory cycles

o coagulation disorderso blood dyscrasiasohypothyroidism

ETIOLOGY

FACTORS DETERMINING THE CHOICE OF TREATMENT

◦Age

◦Parity

◦Histopathological changes in Endometrium

◦Need for contraception

◦Availability of treatment option

3

2

1Early control of excessive bleeding

Normalizing cyclical rhythms

Prevention of recurrence

TREATMENT

OBJECTIVES

Management

MILD PUBERTAL MENORRHAGIA

◦Reassurance

◦Maintenance of menstrual calendar, pictorial bleeding assessment chart & assessment of menstrual blood loss

◦Iron & Vitamin Supplementation

◦Periodic re-evaluation

MILD (..contd)• No Specific treatment required• Normal menstrual pattern occurs spontaneously

within 1 or 2 years

SEVERE PUBERTAL MENORRHAGIA

o ADMISSION OF THE PATIENTo Blood Transfusiono RULE OUT

Hypothyroidism-thyroid profile

Bleeding diathesis - FBC, platelet count, bleeding time, PTT,vwf antigen

oTo Achieve HemostasisoHigh dose progestogeno Norethisterone acetate

o 1st 48hrs 5-10mg tdso Next 2 weeks 5-10mg bdo Next 1 week 5-10mg odo Then stop the drug

oTo Regularise Menstrual CyclesoCyclical progestogen for 6 months or longer

oRe-evaluation upto 12 months or longer if necessary

OCP-20-30 microgram tabs

mefenemic acid 500 mg tds for 6 days

OTHER DRUGS

tranexemic acid 500-1000 mg 8 hourly

GnRH-leuprolide -3.75 mg im monthly for 6 months

• DILATATION AND CURETTAGE (D&C)

– Last resort

– To rule out Tuberculous Endometritis (4% of cases)