Juvenile metrorrhagia
Kessler, I.; Lancet, M.; Appelman, Z.; Rozenman, D.
Harefuah 108(4): 169-172
1985
ISSN/ISBN: 0017-7768 PMID: 4007659 Document Number: 263316
A series of 75 cases of juvenile metrorrhagia (M) (up to the age of 20) is reviewed. In 1/2 of the cases the M was primary and in the other 1/2 it started after a period of normal menses. Abnormal findings in the genitalia were noted in only 3 cases: in 2, enlarged ovaries were found and 1 had a cervical carcinosarcoma. In 28% of the cases Hb was < 10 g% and in 10 < 6 g%. The earlier the M began, the more severe its complications. D and C proved the best mode of treatment but 'medical curettage' with hormonal therapy was also effective. D and C obviated re-admission in most cases. Cyclic administration of combined pills was effective in preventing recurrence of M. Endometrial hyperplasia was found in only 17.6% of the curettings and in another 17.6% atrophic endometrium was found. Of the 75 patients, 42 have been followed for 2-20 yr. Fifty-eight percent of them continued to suffer from M, especially those with primary juvenile M, with heavy flow and after repeated admissions. They probably represent more severe dysfunction of the hypothalamus-hypophysis-ovarian axis and should have more careful follow-up. They should receive preventive therapy for a prolonged period. Of 23 women having regular intercourse, 15 (65.2%) became pregnant spontaneously but 8 had primary sterility. Three of the latter conceived after clomiphene treatment. D and C and hormonal therapy were equally effective as primary treatment, but cyclic administration of combined pills was needed in order to prevent early and late recurrences of M.