Treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center

Abstract

Background: Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. Puberty menorrhagia is excessive bleeding occurring between menarche and 19 years. The leading cause of puberty menorrhagia is hypothalamic pituitary-ovarian axis immaturity followed by bleeding disorders and endocrine disorders. Excessive blood loss leading to anemia has a negative impact over the development and quality of life of the adolescent, requiring immediate attention to these cases. The objective is to evaluate the treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center. Aims and Objectives: The aim of the study was to evaluate the treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center. Materials and Methods: A retrospective and observational study was done on adolescents admitted for management of puberty menorrhagia in Kempegowda Institute of Medical Sciences over a period lasting from January 2017 to October 2021 from hospital records. Results: Among the 35 admitted, 42% belonged to the age group 10–14 years. About 62.8% presented with symptoms lasting <6 months. About 20% presented with hemoglobin <4 g, 51.4% with hemoglobin between 4 g and 6 g, 28.6% with 6 g to 8 g. About 57.2% of patients had anovulatory cycles, 25.7% were PCOS, 11.4% had hypothyroidism, and 5.7% had fibroid uterus. About 42% ultrasonographies showed PCOS, 5.7% had fibroid uterus. The approach to managing these patients depends on the presentation of the patient. Severe anemia is treated with blood transfusion for anemia correction. For the cessation of bleeding anti fibrinolytic tranexemic acid, ethamsylate and hormone therapy with medroxyprogesterone and norethisterone is used. Combined oral contraceptives are also used. In our study, 20% received tranexemic acid and hematinics. About 31.42% received blood, hematinics, and tranexemic acid, 11.42% received hematinics, tranexemic acid, and thyroxine, 17.14% received blood, haematinics, tranexemic acid, and progesterone, 8.57% received hematinics, tranexemic acid, and COCs, 11.42% received hematinics, tranexemic acid, and progesterone. Conclusion: Patients with severe anemia required treatment with packed cells while moderate anemia were corrected with parenteral iron. To control bleeding, tranexemic acid and ethamsylate were sufficient but in 45% of them bleeding was persistent and in them, progestins like medroxyprogesterone and norethisterone were required for cessation of bleeding. In cases where hypothyroidism was diagnosed, thyroxine was started. Medical management was successful in all cases.