A 14-year-old female has menometrorrhagia with a moderate increase in menstrual flow and irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?

A 14-year-old female has menometrorrhagia with a moderate increase in menstrual flow and irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?

• A. Iron supplementation and prostaglandin inhibitors
• B. One OCP twice daily for 3 to 4 days and then daily
• C. Progestin every day for 10 to 14 days
• D. Referral to a pediatric gynecologist for treatment

Answer: (A)

The main idea is to treat heavy menstrual bleeding in a teen by reducing the blood loss and protecting iron stores. Prostaglandin inhibitors (NSAIDs) help with this because they lower prostaglandin synthesis in the uterus, leading to reduced uterine contractions and less menstrual bleeding. They’re a common first-line option for adolescents with heavy menses and irregular cycles. Iron supplementation is added to prevent or treat iron deficiency from ongoing heavy bleeding. Even if her current hemoglobin is normal, repeated heavy periods can deplete iron stores over time, so starting iron support while monitoring iron status is sensible. If bleeding remains heavy despite NSAIDs and iron, hormonal therapies (like combined oral contraceptives or progestin regimens) or referral to a pediatric gynecologist may be considered. But starting with NSAIDs to reduce bleed and iron to protect stores fits this scenario.

The main idea is to treat heavy menstrual bleeding in a teen by reducing the blood loss and protecting iron stores. Prostaglandin inhibitors (NSAIDs) help with this because they lower prostaglandin synthesis in the uterus, leading to reduced uterine contractions and less menstrual bleeding. They’re a common first-line option for adolescents with heavy menses and irregular cycles.

Iron supplementation is added to prevent or treat iron deficiency from ongoing heavy bleeding. Even if her current hemoglobin is normal, repeated heavy periods can deplete iron stores over time, so starting iron support while monitoring iron status is sensible.

If bleeding remains heavy despite NSAIDs and iron, hormonal therapies (like combined oral contraceptives or progestin regimens) or referral to a pediatric gynecologist may be considered. But starting with NSAIDs to reduce bleed and iron to protect stores fits this scenario.