IMPE Abstracts

Introduction: Abnormal uterine bleeding (AUB) as excessive menstrual blood loss, affects the patient's quality of life. The causes of AUB in adolescence are non-structural and within these by far the disovulation secondary to immature hypotalamus-gonadal hypophysis (90%).

Clinical Case: 14-year-old. menarche at 10 yo, oligo-amenorrhea. She presents with AUB of 15 days of evolution and functional anemic syndrome. From the examination obesity with BMI 34 kg/m2. Cutaneous-mucosal pallor, without hemorrhagic lesions. BP 110/70 mmHg. Genitalia Tanner Stage V, without vulvar or vaginal lesions. Moderate non-foetid metrorrhagia. Biochemistry compatible with hypochromic microcytic anemia (Hb of 6.8 g / dl), which required transfusion on 2 occasions, normal crasis, hepatogram. antigenic Von Willebrand Factor, normal ristocetin and coagulation factors, platelet normoaggregation "in vitro" with different inducers. She persisted with abundant genitourinary enlargement. Treatment based on Tranexamic acid 1g I/V every 8 hs and ethinylestradiol 20 mg / Levonorgestrel 0.1mg (OCP) every 6 hs until cessation of bleeding and then continued with OCP 1 pill/ day, she was discharged with low genitorrhagia but reinstated at 6 days with a new AUB. Hormonal treatment is reinstated and start Leuprolide acetate 7.5 mg/3 months. Given the symptomatic persistence with functional anemic syndrome and the report of the CT scan compatible with hematometry, hysteroscopy was performed and numerous intracavitary clotting was aspirated, no organic lesions were found and an endometrial biopsy was performed. Levonorgestrel releasing intrauterine device is placed for long term AUB treatment with clear improvement of the general condition, at one month without genitorrhagia and without functional anemia.

Discussion: Once organic causes have been ruled out, the majority of AUB are due to an alteration in the physiological integrity of the gonadal axis, dysovulation. OACs are the first line of treatment at high doses, in our patient the poor response to initial treatment with antifibrinolytics and OACs is striking, continuing with more interventional treatments. Antifibrinolytics decrease bleeding by 40-50% in patients with AUB and can be administered in conjunction with OAC. Fertility-preserving surgical options include balloon tamponade and suction evacuation or suction and curettage. The LNG-IUD has been shown to reduce heavy menstrual bleeding in all women as it did in our patient, enhancing axis suppression for 3 months to avoid repeated transfusions.

Conclusion: AUB may be a sentinel for an underlying bleeding disorder. Multidisciplinary evaluation and management is essential for correct diagnosis and treatment, as well as multidisciplinary intervention for weight loss.