Page 1 of 1: puberty menorrhagia not responding to harmone therapy

anavrin_kaerf · Credits: 4114 My Scrapbook

Not responding to hormone therapy should be treated by
1.Hysteroscopic endometrial ablation
2.GnRH given for one year
3.Danazol
4.Mirena IUCD

aceofbase · Credits: 1715 My Scrapbook

Hysterosocpic endometrial ablation

drjanak · Credits: 3151 My Scrapbook

puberty menorrhagia not responding to harmone therapy

Not responding to hormone therapy should be treated by
1.Hysteroscopic endometrial ablation
2.GnRH given for one year
3.Danazol
4.Mirena IUCD

Berek & Novak's Gynecology 14th Ed- Chapter 14-Benign Diseases of the Female Reproductive Tract – Adolescent Age group – Abnormal Bleeding - Management
The failure of hormonal management suggests that a local cause of bleeding is more likely. In this event, consideration should be given to a pelvic ultrasonographic examination to determine any unusual causes of bleeding (such as uterine leiomyomas or endometrial hyperplasia) and to assess the presence of intrauterine clots that may impair uterine contractility and prolong the bleeding episode. If intrauterine clots are detected, evacuation of the clots (suction curettage or D & C) is indicated. Although a D & C will provide effective immediate control of the bleeding, it is unusual to reach this step in adolescents.
More drastic forms of treatment other than a D & C (such as ablation of the endometrium by laser or cryotherapy) are considered inappropriate for adolescents because of concerns about future fertility.

Long-term Menstrual Suppression
For patients with underlying medical conditions, such as coagulopathies or a malignancy requiring chemotherapy, long-term therapeutic amenorrhea with menstrual suppression using the following regimens may be necessary:
Progestins such as oral norethindrone, norethindrone acetate, or medroxyprogesterone acetate on a continuous daily basis. OR
Continuous (noncyclic) combination regimens of oral estrogen and progestins (birth control pills) that do not include a withdrawal bleeding–placebo week OR
Depot formulations of progestins (DMPA), with or without concurrent estrogens OR
Gonadotropin-releasing hormone (GnRH) analogs with or without estrogen add-back therapy OR
Levonorgestrel intrauterine system (IUS)

The choice of regimen depends on the presence of any contraindications (such as active liver disease precluding the use of estrogens) and the clinician's experience. Although the goal of these long-term suppressive therapies is amenorrhea, all of these regimens may be accompanied by breakthrough bleeding.

My personal opinion is that hormone therapy will practically always arrest menorrhagia in the adolescent. If it does not work I would be inclined to use a GNRH analoge. My reasoning is as follows:
Endometrial ablation - can impair fertility for ever
Danazol - lot of side effects
Intrauterine device - requires examination, operative insertion in an unmarried adolescent. Extremely difficult to accept internal examination, internal interference and then "contraceptive insertion" in an unmarried girl in the Indian context.

aceofbase · Credits: 1715 My Scrapbook

YES, I THINK YOU ARE ON THE RIGHT TRACK. THANKS FOR THE CORRECTION

puberty menorrhagia not responding to harmone therapy

Not responding to hormone therapy should be treated by
1.Hysteroscopic endometrial ablation
2.GnRH given for one year
3.Danazol
4.Mirena IUCD

Berek & Novak's Gynecology 14th Ed- Chapter 14-Benign Diseases of the Female Reproductive Tract – Adolescent Age group – Abnormal Bleeding - Management
The failure of hormonal management suggests that a local cause of bleeding is more likely. In this event, consideration should be given to a pelvic ultrasonographic examination to determine any unusual causes of bleeding (such as uterine leiomyomas or endometrial hyperplasia) and to assess the presence of intrauterine clots that may impair uterine contractility and prolong the bleeding episode. If intrauterine clots are detected, evacuation of the clots (suction curettage or D & C) is indicated. Although a D & C will provide effective immediate control of the bleeding, it is unusual to reach this step in adolescents.
More drastic forms of treatment other than a D & C (such as ablation of the endometrium by laser or cryotherapy) are considered inappropriate for adolescents because of concerns about future fertility.

Long-term Menstrual Suppression
For patients with underlying medical conditions, such as coagulopathies or a malignancy requiring chemotherapy, long-term therapeutic amenorrhea with menstrual suppression using the following regimens may be necessary:
Progestins such as oral norethindrone, norethindrone acetate, or medroxyprogesterone acetate on a continuous daily basis. OR
Continuous (noncyclic) combination regimens of oral estrogen and progestins (birth control pills) that do not include a withdrawal bleeding–placebo week OR
Depot formulations of progestins (DMPA), with or without concurrent estrogens OR
Gonadotropin-releasing hormone (GnRH) analogs with or without estrogen add-back therapy OR
Levonorgestrel intrauterine system (IUS)

The choice of regimen depends on the presence of any contraindications (such as active liver disease precluding the use of estrogens) and the clinician's experience. Although the goal of these long-term suppressive therapies is amenorrhea, all of these regimens may be accompanied by breakthrough bleeding.

My personal opinion is that hormone therapy will practically always arrest menorrhagia in the adolescent. If it does not work I would be inclined to use a GNRH analoge. My reasoning is as follows:
Endometrial ablation - can impair fertility for ever
Danazol - lot of side effects
Intrauterine device - requires examination, operative insertion in an unmarried adolescent. Extremely difficult to accept internal examination, internal interference and then "contraceptive insertion" in an unmarried girl in the Indian context.

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