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teen nonstop bleeding
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ablevon posted:
My daughter is 13 years old and her menstrual will not stop. back in Late Nov she had her period for 3 weeks stopped for 2 weeks and started again but this time she hasn't stopped. we put her on microgestin 1-20 and after 12 days of being on the pill it hasn't stopped the Dr said try 3 tabs for 2 days then 2 tabs for 2 days. She still hasn't stopped bleeding she also has cramping. Went yesterday to see a gyn Dr and she says it's her hormones. But this morning at 4am she woke me up complaining of stomach cramping. Could there be more to this problem? Should I ask for a sonogram?
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Jane Harrison Hohner, RN, RNP responded:
Dear ablevon: An ultrasound might find an ovarian cyst and/or a thickened uterine lining, but in essence the GYN is giving you correct information. Amazingly, young women in the first three years after first menses (menarche) are in the same hormonal status as women in their last years of reproduction.

At both ends of the age spectrum the hormonal issue is the same. In the young women there are often infrequent ovulations as it can take up to three years for regular ovulations to develop. In the perimenopausal woman aging ovaries still produce estrogen but ovulation (and fertility) are on the decline. So why would this cause the type of gushing bleeding seen at both ages?

Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining ), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. Progesterone is naturally produced by the ovary after an ovulation has occurred. So in both our examples the women have adequate estrogen but not enough progesterone due to infrequent ovulations.

As mentioned above, an ultrasound may show a very thick uterine lining (no lawnmower activity). Also, the presence of an ovarian cyst can temporarily interfere with ovulations.

ablevon, while this is the most likely explanation for heavy, prolonged bleeding in a 13 year old there are a couple of other, rare causes. For example in teen women perhaps 10% will have an undetected blood clotting disorder which is evident only in heavy menstrual bleeding. Your GYN can test for some of the less common culprits if indicated.

The usual treatment is to try hormones first. Thus I would continue to follow the GYN's instructions. Do let them know about the increased cramping in case an ovarian cyst is present. Hopefully the bleeding will abate. If infrequent ovulations are the problem things usually work out with time.

Yours,
Jane


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