Pubey menorrhagia is treated by :

Ans. is a, b and c i.e. Progesterone; Progesterone & estrogen; and GnRH analogues Most common cause of pubey menorrhagia is Anovulatory cycles - so the girl should be managed initially with - Explanation - Reassurance - Mefenamic acid & - Psychological suppo - Correction of anaemia tranexemic acid In refractory cases: potent progesterone eg. Medroxy progesterone acetate is given until bleeding stops. Progesterone and oral contraceptive pills both are used during episodes of bleeding and later to regularize and control menstrual bleeding. Oestrogen therapy alone yields very good results but is not recommended due to its high dose and side effects and is reserved only for emergency situations. Danazol is contraindicated in young girls as it causes hirsutism. In case hormone therapy fails, curettage of endometrium ican be done to rule out genital TB, (seen in 4% of these young girls) or presence of intrauterine clots. Use of GnRH analogues : "For adolescent patients with coagulopathies or malignancy requiring chemotherapy, long term therapeutic amenorrhea with menstrual suppression using GnRH analogues can be achieved." Other therapies : Desmopressin - synthetic analogue of vasopressin is given in case of Von Willebrand disease. In patients not responding to medical therapy - Mirena IUCD is inseed. It causes thining of the endometrium. Rarely when uterine aerio venus aneurysm exists, embolisation of uterine aery is done