The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche.

Abstract

We sought to evaluate the impact of estrogen-containing treatment for heavy menstrual bleeding (HMB) on subsequent height compared to progesterone-only or non-hormonal treatment when initiated at menarche. We performed a retrospective chart review of adolescent females aged 10-15 years who presented to an institution-affiliated outpatient, inpatient, or emergency setting for management of HMB within three months of menarche. Growth records over a 2 year period starting at menarche were recorded, and comparisons made among patients treated with 1) estrogen, 2) progesterone, and 3) non-hormonal methods (controls). Groups were compared using bivariate analysis with Chi-square or Fisher's exact test and linear regression. In an analysis of 80 patients at 24months, the mean increase in height from menarche was 6.4cm among controls (n=54), 7.2cm among the progesterone-only group (n=10), and 3.8cm among the estrogen group (n=16). The estrogen group's increase in height was significantly lower than the control group's, by a mean of 1.8cm (p=0.04). Change in height did not differ significantly between the progesterone and control groups (p=0.87). Additionally, for every year younger at menarche, there was 1 fewer cm of growth (change in height) at 24months after menarche (p<0.002). Estrogen-containing treatment for HMB initiated within three months of menarche was associated with reduced growth at 24months compared to progesterone-only or non-hormonal methods. The clinical applicability of the estrogen group's 1.8cm absolute reduction in height may have considerable significance for those who are shorter at baseline.