The clinical and pathologic features of puberty hemorrhage

Abstract

Puberty bleeding clinically designates menorrhagia or metrorrhagia occurring early in menstrual life. These abnormalities are locally independent of inflammation, neoplasia and the pregnant state, as well as of the varied blood dyserasias. They are closely allied to the essential bleeding occurring at the menopause and clinically as well as pathologically both forms overlap. In this communication the puberty group is stressed.A review of 26 cases from the gynecologic services of the General Memorial and Long Island College Hospitals emphasizes the following characters of this disease. 1.1. Primary menstrual anomalies: Both menorrhagia or metrorrhagia may set in as the initial epoch of sex life or supervene more slowly following oligomenorrhea, hypomenorrhea or other disorders of menstruation.2.2. Absence of abnormalities in the general physical examination: This is true in the great majority of cases; yet two in this series showed definite endocrine dyscrasia. Though only fourteen years of age, both of these girls were fully matured, with mammae well formed, the external genitalia fully developed, and the uterus large. The unusual height, 5 ft. 10 in, in one and 5 ft. 6 in, in the other were indicative of abnormal pituitary stimulation.3.3. Normal bleeding and clotting time. These tests were performed where secondary anemia was unduly severe and as a rule prior to transfusion. In six instances the findings were within the normal.4.4. Pelvic abnormalities: In all cases, the cervix was found unusually soft and patulous. In addition several were noted with enlarged uteri. In all the curettings were abundant and hyperplastic.5.5. Recurrence of symptoms after curettage was the rule where abrasion was performed as a therapeutic measure.6.6. Excellent therapeutic response, with control of symptoms by radium was universal, even though small quantities were employed.These features are well demonstrated in seven typical cases abstracted below.