Case of a Girl with Heavy, Prolonged Periods and Anemia
Shelby is an 11-year-3-month-old girl with heavy menstrual bleeding for the past 25 days, fatigue, and moderate anemia. She had her first menstrual period 9 months ago and has had six menses at irregular intervals. Her physical exam is normal as are laboratory tests for hormone dysfunction and bleeding disorders. Her abnormal uterine bleeding is likely related to ovulatory dysfunction from HPO axis immaturity. A combined (estrogen/progestin) oral contraceptive (COC) pill will stabilize the endometrium and prevent further bleeding. An appropriate plan is to administer a COC pill two times per day for 2 or 3 days to stop the bleeding and then once daily to prevent further bleeding. Shelby should also begin a therapeutic dose of oral iron with a stool softener. Once anemia is corrected, it is reasonable to discontinue the COC pills. Thereafter, Shelby should track her menses on a menstrual calendar and see her clinician frequently to monitor for recurrence.
KeywordsAbnormal uterine bleeding (AUB) Anemia Gynecologic age HPO axis immaturity Combined oral contraceptives (COC)
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