OB-GYN-L Messages for February, 1999: Menorrhagia for 6 Months in a 31-Year-Old

Disclaimer: The Virtual Consult is provided as an educational tool for clinicians. The goal is to open an educational dialogue among clinicians on challenging areas of disease management. It is not intended for the purposes of soliciting or recommending treatment or diagnosis for any specific patient.

History of Presenting Illness: This 31-year-old woman, of normal weight and otherwise in good health, has had menorrhagia for over 6 months, with daily heavy blood loss accompanied by some abdominal pain.

Ob/Gyn History: History of anorexia (6 yrs). Patient did not menstruate for 7 years, had a sporadic menstrual cycles for 2 years, and was diagnosed with polycystic ovarian syndrome at age 24. Cysts were seen on ovaries, and the right ovary was in pouch of Douglas. Patient conceived during irregular cycle 2 years later, but the pregnancy was aborted and the patient was sterilized. Menstrual cycles resumed, but they remained very irregular (3 bleeds per annum). At age 30, her bleeding became constant and heavy. Bleeding has now continued daily for 6 months continuously.

Other History: Acute and prolonged clinical depression. There is a high incidence of cancer and stroke in the family history.

Current Meds: None prior to present illness. Progesterone 10mg prescribed to suppress bleeding.

Physical Exam: Laparoscopy revealed thick and extended womb lining but no apparent cell abnormality. Biopsy revealed endometrial cystic hyperplasia.

Impression & Treatment Plan: Endometrial ablation versus hysterectomy to halt bleeding apparently caused by endometrial cystic hyperplasia. Any other options, given the patient's youth (31 yrs)?

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From
Medscape Women's Health
Virtual Consult
Menorrhagia for 6 Months in a 31-Year-Old

What treatment options would you advise for a young woman with vaginal bleeding of 6 months' duration? Malcolm Griffiths, MD, in the Department of Obstetrics and Gynaecology, Luton & Dunstable Hospital, Luton, UK, moderates this case. [Medscape Women's Health 4(1), 1999. © 1999 Medscape, Inc.]

Disclaimer: The Virtual Consult is provided as an educational tool for clinicians. The goal is to open an educational dialogue among clinicians on challenging areas of disease management. It is not intended for the purposes of soliciting or recommending treatment or diagnosis for any specific patient.

History of Presenting Illness: This 31-year-old woman, of normal weight and otherwise in good health, has had menorrhagia for over 6 months, with daily heavy blood loss accompanied by some abdominal pain.
Ob/Gyn History: History of anorexia (6 yrs). Patient did not menstruate for 7 years, had a sporadic menstrual cycles for 2 years, and was diagnosed with polycystic ovarian syndrome at age 24. Cysts were seen on ovaries, and the right ovary was in pouch of Douglas. Patient conceived during irregular cycle 2 years later, but the pregnancy was aborted and the patient was sterilized. Menstrual cycles resumed, but they remained very irregular (3 bleeds per annum). At age 30, her bleeding became constant and heavy. Bleeding has now continued daily for 6 months continuously.
Other History: Acute and prolonged clinical depression. There is a high incidence of cancer and stroke in the family history.
Medical History: Rheumatic fever; anorexia/bulimia
Current Meds: None prior to present illness. Progesterone 10mg prescribed to suppress bleeding.
Physical Exam: Laparoscopy revealed thick and extended womb lining but no apparent cell abnormality. Biopsy revealed endometrial cystic hyperplasia.
Lab Data: Bone density normal
Impression & Treatment Plan: Endometrial ablation versus hysterectomy to halt bleeding apparently caused by endometrial cystic hyperplasia. Any other options, given the patient's youth (31 yrs)?

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