Severe Puberty Menorrhagia Presenting With Life- Threatening Anemia in a 14-year-old Girl From Andhra Pradesh: A Case Report

Severe Puberty Menorrhagia Presenting With Life- Threatening Anemia in a 14-year-old Girl From Andhra Pradesh: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Severe Puberty Menorrhagia Presenting With Life- Threatening Anemia in a 14-year-old Girl From Andhra Pradesh: A Case Report Sai Krishna Reddy Konda, Pavan Kumar Yanamadala, Geethanjali Katta, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7508420/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Abnormal uterine bleeding in adolescents (AUB-A) represents a prevalent gynaecological issue, with menorrhagia during puberty frequently occurring in the initial years following menarche. Although it is typically benign and associated with the immaturity of the hypothalamic–pituitary–ovarian axis, a late diagnosis can lead to significant anaemia and potentially life-threatening complications. Case Details: We report a 14-year-old girl with 15 days of continuous vaginal bleeding, pallor, tachycardia, and hypotension. Lab tests showed a haemoglobin level of 2.1 g/dL, indicating iron deficiency anaemia. Coagulation and endocrine tests were normal, ruling out bleeding disorders and systemic causes. She was diagnosed with menorrhagia due to anovulatory cycles. Her treatment included intravenous tranexamic acid, norethisterone, iron supplements, methylprednisolone, and one unit of packed red blood cells. Over two weeks, her haemoglobin improved to 8.5 g/dL, and she stabilised clinically. Discussion: This case underscores the necessity for a thorough assessment of adolescent menorrhagia to rule out coagulopathies and endocrine disorders, in addition to the prompt implementation of evidence-based multimodal treatment. The degree of anaemia noted in this instance illustrates the consequences of late presentation, frequently influenced by sociocultural stigma and restricted access to healthcare in India. Conclusion: Menorrhagia during puberty necessitates careful clinical evaluation and prompt treatment to avert unnecessary health complications. Recording these instances aids in closing the gaps in the literature concerning adolescent gynaecology, particularly in resource-constrained environments. Menorrhagia Adolescent Health Anemia Iron-Deficiency Hypothalamic–Pituitary–Gonadal Axis Tranexamic Acid India BACKGROUND Abnormal uterine bleeding (AUB) among adolescents is a common gynaecological issue that has a considerable impact on health, education, and psychosocial well-being. The term AUB is now favoured over previous terminology such as "menorrhagia" to enhance clarity and to include both menstrual irregularities and excessive bleeding 1 . In teenagers, the primary reason for heavy menstrual bleeding (HMB) is anovulatory dysfunction caused by the immaturity of the hypothalamic-pituitary-ovarian (HPO) axis. In the initial post-menarche phase, the hypothalamus-pituitary-ovarian axis frequently does not produce consistent, synchronised cycles, which results in unopposed estrogen stimulation, unpredictable endometrial growth, and irregular bleeding 1 , 2 . A recent systematic review and meta-analysis 3 involving 2,770 adolescents suffering from heavy menstrual bleeding (HMB) revealed that the primary causes were ovulatory disorders (23.7%), closely followed by coagulation disorders (19.4%) and platelet disorders (6.2%). Notably, almost 46% of the cases were attributed to idiopathic origins. This highlights the necessity of taking into account both hormonal and hemostatic factors during the assessment of abnormal uterine bleeding (AUB). Indeed, coagulopathies represent significant factors: around 20% of adolescents experiencing heavy menstrual bleeding (HMB) have associated bleeding disorders, such as von Willebrand disease and platelet dysfunctions; this percentage rises to 33% in individuals who necessitate hospitalisation due to severe bleeding 2 , 3 . These observations underscore the importance of early detection of bleeding disorders in adolescent females suffering from heavy menstrual bleeding. Heavy menstrual bleeding has considerable implications for education and quality of life. In Turkey, approximately 48% of adolescent girls have encountered heavy menstrual bleeding (HMB), but merely 23% pursued medical assistance; furthermore, those impacted indicated lower overall quality-of-life ratings in comparison to their counterparts 4 . This disparity highlights the systemic obstacles present in health-seeking behaviours. India also encounters distinct socio-cultural and healthcare accessibility challenges. The stigma surrounding menstruation and the normalisation of excessive bleeding frequently result in delayed medical attention, with young girls arriving late at tertiary care facilities and often already suffering from anaemia. Despite this pressing concern, there exists a significant lack of thoroughly documented case studies that demonstrate organised diagnostic approaches and effective management strategies in resource-constrained environments within India. Considering the wide array of causes, spanning from physiological anovulation to bleeding disorders, and the significant systemic, educational, and psychosocial consequences, a comprehensive, multidisciplinary diagnostic strategy is crucial. The foundational assessment encompasses a detailed medical history, physical examination, complete blood count (CBC), iron studies, coagulation tests, endocrine assessment, and imaging as necessary 2 , 5 . Treatment options depend on antifibrinolytics (such as tranexamic acid), hormonal treatments, iron supplementation, and, when required, blood transfusion. Despite an increasing awareness, well-documented clinical cases that outline the complete diagnostic and therapeutic processes in low-resource environments, particularly in India, are still limited. This case report seeks to address that deficiency by detailing the case of a 14-year-old girl suffering from severe menorrhagia during puberty and life-threatening anaemia. It describes a systematic investigation, evidence-based management, and the resulting outcomes, thus enhancing clinical care and awareness in comparable situations. CASE DETAILS A 14-year-old girl, weighing 35 kg and measuring 160 cm in height, was admitted on June 24, 2025, presenting with the primary complaint of persistent vaginal bleeding lasting for 15 days. The patient had experienced menarche 5 months earlier and indicated that her menstrual cycles had been regular since that time. Her most recent menstrual period began on June 9, 2025, and the bleeding lasted for 10 days. After a symptom-free interval of 3 days, she experienced another episode of significant bleeding starting on June 21, 2025, which continued until her admission. She noted the passage of large clots and reported the use of 6 to 7 sanitary pads daily. There were no accompanying symptoms of dysmenorrhea, fever, abdominal pain, or any history indicative of a systemic bleeding disorder. Her past medical history was unremarkable, and there was no family history of bleeding disorders. Upon general assessment, the patient exhibited significant pallor accompanied by tachycardia (pulse: 120 bpm) and hypotension (BP: 90/50 mmHg). She presented as afebrile and alert. The physical examination indicated conjunctival pallor, with no signs of hepatosplenomegaly or lymphadenopathy. The abdomen was found to be soft and non-tender. Initial laboratory assessments indicated a significant case of iron deficiency anaemia, with a haemoglobin level of 2.1 g/dL upon admission, a serum iron measurement of 34.1 µg/dL (which is considered low), and an elevated total iron binding capacity (TIBC) of 442.7 µg/dL. The trends in haemoglobin levels showed a steady improvement, rising from 3.1 g/dL on June 26th to 8.5 g/dL by July 7th, following appropriate supportive care. Both the platelet count and coagulation profile were found to be within normal ranges, effectively excluding the possibility of an underlying bleeding disorder. The patient was initially stabilised with intravenous tranexamic acid (500 mg) and botropase. She was then initiated on treatment for management of severe anaemia and iron-folic acid with vitamin C supplementation, calcium, and norethisterone. A unit of packed red blood cells was transfused on the second hospital day. Subsequently, she received additional supportive treatment including repeated doses of tranexamic acid, short courses of intravenous methylprednisolone (initially 125 mg daily for 3 days, later switched to oral 40 mg once daily), and symptomatic therapy with ondansetron, pantoprazole, and paracetamol. Hormonal therapy with norethisterone was titrated (ranging from 5 mg QID to BD) depending on daily bleeding severity and response. Throughout the duration of hospitalisation, the patient experienced sporadic gastrointestinal side effects, including black tarry stools, nausea, and vomiting, which may be linked to iron supplementation or corticosteroid treatment. Additionally, she reported intermittent headaches and blurred vision, both of which showed improvement with supportive care. Continuous monitoring of haemoglobin levels indicated a gradual enhancement, culminating in stabilisation at 8.5 g/dL upon discharge. By the conclusion of the second week of therapy, menstrual bleeding had significantly decreased, and the patient achieved hemodynamic stability. Based on clinical presentation and investigations, a diagnosis of puberty menorrhagia with severe iron deficiency anaemia was established. The patient was successfully managed with blood transfusion, hormonal regulation, iron supplementation, and supportive care. She was counselled regarding adherence to therapy, dietary modifications to improve iron intake, and the need for close follow-up with pediatric and gynaecology teams to prevent recurrence. DISCUSSION This report details a remarkable instance of menorrhagia during puberty in a 14-year-old girl, marked by persistent heavy bleeding, critically low haemoglobin levels (as low as 2.1 g/dL), and hemodynamic instability. The underlying cause was determined to be anovulatory dysfunctional uterine bleeding, associated with immaturity of the hypothalamic-pituitary-ovarian axis. A comprehensive approach involving antifibrinolytic treatment, hormonal therapy (norethisterone), iron supplementation, and blood transfusion resulted in a gradual increase in haemoglobin levels and clinical stabilisation, highlighting the effectiveness of prompt, multidisciplinary intervention. At the pathophysiological level, anovulation—resulting from the immaturity of the hypothalamic–pituitary–ovarian axis—continues to be the primary cause of menorrhagia during the early post-menarche years, which leads to unopposed estrogen activity and irregular endometrial shedding 6 . Despite this common mechanism, our diagnostic strategy also meticulously ruled out other significant causes, particularly coagulopathies. Research indicates that as many as 12–20% of adolescents experiencing heavy menstrual bleeding may have undiagnosed bleeding disorders 7 , 8 however, our patient's coagulation profile, including von Willebrand factor assays, was found to be normal. Likewise, endocrine disorders such as hypothyroidism and polycystic ovary syndrome (PCOS), which are recognised contributors to menorrhagia, were thoroughly excluded through appropriate testing 9 . When compared to contemporary Indian literature, the presentation of our patient exhibits significant etiological similarities: Yadav et al. in 2022 6 documented anovulatory cycles in approximately 78% of adolescent menorrhagia instances, with lesser contributions from bleeding disorders and endocrine issues. Varadarajan & Yoganarasimha in 2022 9 similarly noted that 57% of cases were anovulatory, 25–26% were attributed to PCOS, and around 11% were linked to hypothyroidism. What distinguishes our case is the pronounced severity of anaemia, haemoglobin levels dropping to as low as 2.1 g/dL—surpassing the levels typically reported, which are often within the 4–6 g/dL range. Furthermore, our dynamic and high-dose hormonal strategy, complemented by antifibrinolytics and transfusions, exemplifies a sophisticated and aggressive management approach that is rarely detailed in the current Indian case literature. This case also underscores the wider clinical and sociocultural ramifications within the Indian context. Adolescents often face delays in receiving care due to menstrual stigma, the normalisation of excessive bleeding, and a lack of menstrual health education, especially in under-resourced areas. These obstacles lead to late presentations, frequently resulting in life-threatening anaemia, as illustrated in this instance. A study conducted by Hukkeri et al. in 2025 10 involving 120 adolescents, found that 70.8% were anaemic, 12.5% exhibited coagulation abnormalities, and 15.8% had thyroid dysfunction, highlighting the multifaceted nature of heavy menstrual bleeding (HMB) and the pressing need for early and structured assessments. Additionally, the psychosocial aspects of menstruation, including stigma and absenteeism, are examined in the research by Radhakrishnan et al. in 2024 11 , emphasising the critical importance of comprehensive menstrual healthcare for adolescents. Undoubtedly, as a single case report, this investigation cannot be widely generalised. Nevertheless, it offers important clinical insights: in adolescent females, even seemingly anovulatory menorrhagia can lead to significant systemic issues if not assessed and treated promptly. The key clinical takeaway is the necessity for a thorough diagnostic evaluation—encompassing medical history, physical examination, anaemia and coagulation tests, and endocrine assessments—and proactive, customised treatment when necessary. This case contributes to the sparse Indian literature on puberty-related menorrhagia, presenting a comprehensive diagnostic and management framework for analogous cases in resource-limited environments, aiming to enhance outcomes for similar future instances. CONCLUSION This case illustrates that menorrhagia during puberty can swiftly escalate from a typical adolescent issue to a serious emergency if not promptly managed. In addition to the individual implications, it underscores the necessity of enhancing menstrual health literacy, facilitating timely access to diagnostic services, and ensuring that healthcare systems are friendly to adolescents in India. Recording such instances contributes to the limited evidence base and serves as a crucial reminder that vigilance, systematic assessment, and immediate intervention are essential to avert preventable morbidity in this at-risk group. Moreover, this report highlights the significant role of case documentation in influencing clinical practice. While extensive studies provide broad recommendations, individual case reports encapsulate the intricacies of diagnostic reasoning, treatment choices, and specific contextual challenges. By doing so, they offer valuable insights for healthcare providers and significantly enrich the growing body of knowledge regarding adolescent gynaecological health. PATIENT PERSEPCTIVE The patient and her parents conveyed a sense of relief after observing an improvement in her condition and expressed gratitude for the prompt medical attention they received. They highlighted that this experience heightened their understanding of menstrual health and underscored the significance of seeking medical assistance promptly in cases of abnormal bleeding. Furthermore, the family indicated their openness to having this case published to assist in raising awareness for other families encountering similar difficulties. Declarations Conflicts of Interest: None declared Funding: None Acknowledgements: The authors express their heartfelt appreciation to the Department of Obstetrics and Gynaecology, along with the clinical team engaged in the patient's care, for their invaluable support and collaboration in managing this case. We also wish to convey our thanks to the patient and her family for their cooperation and consent, as this report would not have been feasible without their involvement. Author Contributions: Sai Krishna Reddy Konda gathered patient information, conducted a review of the literature, and helped in the preparation of the manuscript. Dr. Pavan Kumar Yanamadala conceived the study, oversaw the clinical analysis, and thoroughly revised the manuscript for its intellectual content. Geetanjali Katta aided in literature support. Prof. Rama Rao Nadendla offered academic oversight, direction, and granted final approval for the version intended for publication. All authors have reviewed and consented to the final manuscript and accept responsibility for its content. PATIENT CONSENT Informed consent was secured from the legal guardian of the patient for the publication of this case report, along with any related details. Measures have been implemented to guarantee anonymity, and any identifying information has been omitted to safeguard the patient's privacy. ETHICAL APPROVAL Ethical approval was deemed unnecessary for this case report in accordance with institutional policies and international guidelines, as it details the clinical course of a single patient without any experimental intervention. However, informed consent was secured, and the case has been documented in line with the established ethical standards for case reports. References Kabra R, Fisher M. Abnormal uterine bleeding in adolescents. Current Problems in Pediatric and Adolescent Health Care [Internet]. 2022;52(5):101185. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1538544222000542?via%3Dihub Costlow L. Heavy menstrual bleeding in Adolescents: ACOG Management Recommendations [Internet]. AAFP. 2020. Available from: https://www.aafp.org/pubs/afp/issues/2020/0515/p633.html Hall EM, Ravelo AE, Aronoff SC, Del Vecchio MT. Systematic review and meta-analysis of the aetiology of heavy menstrual bleeding in 2,770 adolescent females. BMC Women S Health [Internet]. 2024;24(1). Available from: https://bmcwomenshealth.biomedcentral.com/articles/ 10.1186/s12905-024-02921-7 Haliç BS, Kocaöz S. Heavy menstrual bleeding in adolescents: Prevalence, quality of life, and treatment-seeking behaviour. Journal of Obstetrics and Gynaecology Research [Internet]. 2025;51(8). Available from: https://obgyn.onlinelibrary.wiley.com/doi/ 10.1111/jog.70016 Borzutzky C, Jaffray J. Diagnosis and management of heavy menstrual bleeding and disorders in adolescents. JAMA Paediatrics [Internet]. 2019;174(2):186. Available from: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2757556 Yadav A, Kaur H, Satyender. Evaluation of puberty menorrhagia in tertiary care centre. International Journal of Reproduction Contraception Obstetrics and Gynecology [Internet]. 2022;11(7):1914. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/11758 Goker ETA, Kizilkan MP, Ersan FG, Akgul S, Aksu T, Aytac S et al. Heavy menstrual bleeding in adolescents: Evaluation of diagnostic indicators and treatment preferences. International Journal of Gynecology & Obstetrics [Internet]. 2024; Available from: https://obgyn.onlinelibrary.wiley.com/doi/ 10.1002/ijgo.16132 American College of Obstetricians and Gynecologists. Committee on Adolescent Health Care. Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG Committee Opinion 785. Obstet Gynecol. 2019;134(3):e71–83. Varadarajan R, Yoganarasimha S. Evaluation of cases of puberty menorrhagia requiring in-patient care. International Journal of Reproduction, Contraception, Obstetrics and Gynaecology [Internet]. 2022;11(7):1921. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/11766 Manjunath MH, Aparna AB, Heena, Anil AM, Rahul RT, Ramita RS. Valuation of incidence prevalence, causes, diagnosis, and treatment of heavy menstrual bleeding in teenagers An Original Research. J Contemp Clin Pract. 2025;11(5):644–50. 10.61336/jccp/25-05-91 . Avaialble from:. Radhakrishnan A, Sharma N, Archunan PA. Menstrual challenges in puberty: Investigating menorrhagia in adolescent girls. Indian Journal of Obstetrics and Gynecology Research [Internet]. 2024;11(4):640–6. Available from: https://ijogr.org/archive/volume/11/issue/4/article/13745#article Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Sep, 2025 Editor assigned by journal 02 Sep, 2025 Submission checks completed at journal 02 Sep, 2025 First submitted to journal 01 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7508420","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":508850245,"identity":"d22be86f-21dc-40ca-9c2e-d391a2b7c891","order_by":0,"name":"Sai Krishna Reddy Konda","email":"","orcid":"","institution":"Chalapathi Institute of Pharmaceutical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sai","middleName":"Krishna Reddy","lastName":"Konda","suffix":""},{"id":508850246,"identity":"10358276-69ef-4ee6-8118-0fe4ece94d78","order_by":1,"name":"Pavan Kumar Yanamadala","email":"data:image/png;base64,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","orcid":"","institution":"Chalapathi Institute of Pharmaceutical Sciences (A)","correspondingAuthor":true,"prefix":"","firstName":"Pavan","middleName":"Kumar","lastName":"Yanamadala","suffix":""},{"id":508850247,"identity":"0d674b77-17e9-4604-8b3d-f1bc8373a22d","order_by":2,"name":"Geethanjali Katta","email":"","orcid":"","institution":"Chalapathi Institute of Pharmaceutical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Geethanjali","middleName":"","lastName":"Katta","suffix":""},{"id":508850249,"identity":"f60164ea-8678-4023-9144-af05bbf627af","order_by":3,"name":"Rama Rao Nadendla","email":"","orcid":"","institution":"Chalapathi Institute of Pharmaceutical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Rama","middleName":"Rao","lastName":"Nadendla","suffix":""}],"badges":[],"createdAt":"2025-09-01 12:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7508420/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7508420/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90491869,"identity":"7e873645-b303-45c6-8b47-aa712804b608","added_by":"auto","created_at":"2025-09-03 09:47:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":364259,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7508420/v1/24f8c86a-0f2f-4a6a-a44c-f64495760113.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSevere Puberty Menorrhagia Presenting With Life- Threatening Anemia in a 14-year-old Girl From Andhra Pradesh: A Case Report\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eAbnormal uterine bleeding (AUB) among adolescents is a common gynaecological issue that has a considerable impact on health, education, and psychosocial well-being. The term AUB is now favoured over previous terminology such as \"menorrhagia\" to enhance clarity and to include both menstrual irregularities and excessive bleeding \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn teenagers, the primary reason for heavy menstrual bleeding (HMB) is anovulatory dysfunction caused by the immaturity of the hypothalamic-pituitary-ovarian (HPO) axis. In the initial post-menarche phase, the hypothalamus-pituitary-ovarian axis frequently does not produce consistent, synchronised cycles, which results in unopposed estrogen stimulation, unpredictable endometrial growth, and irregular bleeding \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eA recent systematic review and meta-analysis \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e involving 2,770 adolescents suffering from heavy menstrual bleeding (HMB) revealed that the primary causes were ovulatory disorders (23.7%), closely followed by coagulation disorders (19.4%) and platelet disorders (6.2%). Notably, almost 46% of the cases were attributed to idiopathic origins. This highlights the necessity of taking into account both hormonal and hemostatic factors during the assessment of abnormal uterine bleeding (AUB).\u003c/p\u003e\u003cp\u003eIndeed, coagulopathies represent significant factors: around 20% of adolescents experiencing heavy menstrual bleeding (HMB) have associated bleeding disorders, such as von Willebrand disease and platelet dysfunctions; this percentage rises to 33% in individuals who necessitate hospitalisation due to severe bleeding \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e. These observations underscore the importance of early detection of bleeding disorders in adolescent females suffering from heavy menstrual bleeding.\u003c/p\u003e\u003cp\u003eHeavy menstrual bleeding has considerable implications for education and quality of life. In Turkey, approximately 48% of adolescent girls have encountered heavy menstrual bleeding (HMB), but merely 23% pursued medical assistance; furthermore, those impacted indicated lower overall quality-of-life ratings in comparison to their counterparts \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e. This disparity highlights the systemic obstacles present in health-seeking behaviours.\u003c/p\u003e\u003cp\u003eIndia also encounters distinct socio-cultural and healthcare accessibility challenges. The stigma surrounding menstruation and the normalisation of excessive bleeding frequently result in delayed medical attention, with young girls arriving late at tertiary care facilities and often already suffering from anaemia. Despite this pressing concern, there exists a significant lack of thoroughly documented case studies that demonstrate organised diagnostic approaches and effective management strategies in resource-constrained environments within India.\u003c/p\u003e\u003cp\u003eConsidering the wide array of causes, spanning from physiological anovulation to bleeding disorders, and the significant systemic, educational, and psychosocial consequences, a comprehensive, multidisciplinary diagnostic strategy is crucial. The foundational assessment encompasses a detailed medical history, physical examination, complete blood count (CBC), iron studies, coagulation tests, endocrine assessment, and imaging as necessary \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e. Treatment options depend on antifibrinolytics (such as tranexamic acid), hormonal treatments, iron supplementation, and, when required, blood transfusion.\u003c/p\u003e\u003cp\u003eDespite an increasing awareness, well-documented clinical cases that outline the complete diagnostic and therapeutic processes in low-resource environments, particularly in India, are still limited. This case report seeks to address that deficiency by detailing the case of a 14-year-old girl suffering from severe menorrhagia during puberty and life-threatening anaemia. It describes a systematic investigation, evidence-based management, and the resulting outcomes, thus enhancing clinical care and awareness in comparable situations.\u003c/p\u003e"},{"header":"CASE DETAILS","content":"\u003cp\u003eA 14-year-old girl, weighing 35 kg and measuring 160 cm in height, was admitted on June 24, 2025, presenting with the primary complaint of persistent vaginal bleeding lasting for 15 days. The patient had experienced menarche 5 months earlier and indicated that her menstrual cycles had been regular since that time. Her most recent menstrual period began on June 9, 2025, and the bleeding lasted for 10 days. After a symptom-free interval of 3 days, she experienced another episode of significant bleeding starting on June 21, 2025, which continued until her admission. She noted the passage of large clots and reported the use of 6 to 7 sanitary pads daily. There were no accompanying symptoms of dysmenorrhea, fever, abdominal pain, or any history indicative of a systemic bleeding disorder. Her past medical history was unremarkable, and there was no family history of bleeding disorders.\u003c/p\u003e\u003cp\u003eUpon general assessment, the patient exhibited significant pallor accompanied by tachycardia (pulse: 120 bpm) and hypotension (BP: 90/50 mmHg). She presented as afebrile and alert. The physical examination indicated conjunctival pallor, with no signs of hepatosplenomegaly or lymphadenopathy. The abdomen was found to be soft and non-tender.\u003c/p\u003e\u003cp\u003eInitial laboratory assessments indicated a significant case of iron deficiency anaemia, with a haemoglobin level of 2.1 g/dL upon admission, a serum iron measurement of 34.1 \u0026micro;g/dL (which is considered low), and an elevated total iron binding capacity (TIBC) of 442.7 \u0026micro;g/dL. The trends in haemoglobin levels showed a steady improvement, rising from 3.1 g/dL on June 26th to 8.5 g/dL by July 7th, following appropriate supportive care. Both the platelet count and coagulation profile were found to be within normal ranges, effectively excluding the possibility of an underlying bleeding disorder.\u003c/p\u003e\u003cp\u003eThe patient was initially stabilised with intravenous tranexamic acid (500 mg) and botropase. She was then initiated on treatment for management of severe anaemia and iron-folic acid with vitamin C supplementation, calcium, and norethisterone. A unit of packed red blood cells was transfused on the second hospital day. Subsequently, she received additional supportive treatment including repeated doses of tranexamic acid, short courses of intravenous methylprednisolone (initially 125 mg daily for 3 days, later switched to oral 40 mg once daily), and symptomatic therapy with ondansetron, pantoprazole, and paracetamol. Hormonal therapy with norethisterone was titrated (ranging from 5 mg QID to BD) depending on daily bleeding severity and response.\u003c/p\u003e\u003cp\u003eThroughout the duration of hospitalisation, the patient experienced sporadic gastrointestinal side effects, including black tarry stools, nausea, and vomiting, which may be linked to iron supplementation or corticosteroid treatment. Additionally, she reported intermittent headaches and blurred vision, both of which showed improvement with supportive care. Continuous monitoring of haemoglobin levels indicated a gradual enhancement, culminating in stabilisation at 8.5 g/dL upon discharge. By the conclusion of the second week of therapy, menstrual bleeding had significantly decreased, and the patient achieved hemodynamic stability.\u003c/p\u003e\u003cp\u003eBased on clinical presentation and investigations, a diagnosis of \u003cb\u003epuberty menorrhagia with severe iron deficiency anaemia\u003c/b\u003e was established. The patient was successfully managed with blood transfusion, hormonal regulation, iron supplementation, and supportive care. She was counselled regarding adherence to therapy, dietary modifications to improve iron intake, and the need for close follow-up with pediatric and gynaecology teams to prevent recurrence.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis report details a remarkable instance of menorrhagia during puberty in a 14-year-old girl, marked by persistent heavy bleeding, critically low haemoglobin levels (as low as 2.1 g/dL), and hemodynamic instability. The underlying cause was determined to be anovulatory dysfunctional uterine bleeding, associated with immaturity of the hypothalamic-pituitary-ovarian axis. A comprehensive approach involving antifibrinolytic treatment, hormonal therapy (norethisterone), iron supplementation, and blood transfusion resulted in a gradual increase in haemoglobin levels and clinical stabilisation, highlighting the effectiveness of prompt, multidisciplinary intervention.\u003c/p\u003e\u003cp\u003eAt the pathophysiological level, anovulation\u0026mdash;resulting from the immaturity of the hypothalamic\u0026ndash;pituitary\u0026ndash;ovarian axis\u0026mdash;continues to be the primary cause of menorrhagia during the early post-menarche years, which leads to unopposed estrogen activity and irregular endometrial shedding \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e. Despite this common mechanism, our diagnostic strategy also meticulously ruled out other significant causes, particularly coagulopathies. Research indicates that as many as 12\u0026ndash;20% of adolescents experiencing heavy menstrual bleeding may have undiagnosed bleeding disorders \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e however, our patient's coagulation profile, including von Willebrand factor assays, was found to be normal. Likewise, endocrine disorders such as hypothyroidism and polycystic ovary syndrome (PCOS), which are recognised contributors to menorrhagia, were thoroughly excluded through appropriate testing \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWhen compared to contemporary Indian literature, the presentation of our patient exhibits significant etiological similarities: Yadav et al. in 2022 \u003csup\u003e\u003cb\u003e6\u003c/b\u003e\u003c/sup\u003e documented anovulatory cycles in approximately 78% of adolescent menorrhagia instances, with lesser contributions from bleeding disorders and endocrine issues. Varadarajan \u0026amp; Yoganarasimha in 2022 \u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e similarly noted that 57% of cases were anovulatory, 25\u0026ndash;26% were attributed to PCOS, and around 11% were linked to hypothyroidism. What distinguishes our case is the pronounced severity of anaemia, haemoglobin levels dropping to as low as 2.1 g/dL\u0026mdash;surpassing the levels typically reported, which are often within the 4\u0026ndash;6 g/dL range. Furthermore, our dynamic and high-dose hormonal strategy, complemented by antifibrinolytics and transfusions, exemplifies a sophisticated and aggressive management approach that is rarely detailed in the current Indian case literature.\u003c/p\u003e\u003cp\u003eThis case also underscores the wider clinical and sociocultural ramifications within the Indian context. Adolescents often face delays in receiving care due to menstrual stigma, the normalisation of excessive bleeding, and a lack of menstrual health education, especially in under-resourced areas. These obstacles lead to late presentations, frequently resulting in life-threatening anaemia, as illustrated in this instance. A study conducted by Hukkeri et al. in 2025 \u003csup\u003e\u003cb\u003e10\u003c/b\u003e\u003c/sup\u003e involving 120 adolescents, found that 70.8% were anaemic, 12.5% exhibited coagulation abnormalities, and 15.8% had thyroid dysfunction, highlighting the multifaceted nature of heavy menstrual bleeding (HMB) and the pressing need for early and structured assessments. Additionally, the psychosocial aspects of menstruation, including stigma and absenteeism, are examined in the research by Radhakrishnan et al. in 2024 \u003csup\u003e\u003cb\u003e11\u003c/b\u003e\u003c/sup\u003e, emphasising the critical importance of comprehensive menstrual healthcare for adolescents.\u003c/p\u003e\u003cp\u003eUndoubtedly, as a single case report, this investigation cannot be widely generalised. Nevertheless, it offers important clinical insights: in adolescent females, even seemingly anovulatory menorrhagia can lead to significant systemic issues if not assessed and treated promptly. The key clinical takeaway is the necessity for a thorough diagnostic evaluation\u0026mdash;encompassing medical history, physical examination, anaemia and coagulation tests, and endocrine assessments\u0026mdash;and proactive, customised treatment when necessary. This case contributes to the sparse Indian literature on puberty-related menorrhagia, presenting a comprehensive diagnostic and management framework for analogous cases in resource-limited environments, aiming to enhance outcomes for similar future instances.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis case illustrates that menorrhagia during puberty can swiftly escalate from a typical adolescent issue to a serious emergency if not promptly managed. In addition to the individual implications, it underscores the necessity of enhancing menstrual health literacy, facilitating timely access to diagnostic services, and ensuring that healthcare systems are friendly to adolescents in India. Recording such instances contributes to the limited evidence base and serves as a crucial reminder that vigilance, systematic assessment, and immediate intervention are essential to avert preventable morbidity in this at-risk group.\u003c/p\u003e\u003cp\u003eMoreover, this report highlights the significant role of case documentation in influencing clinical practice. While extensive studies provide broad recommendations, individual case reports encapsulate the intricacies of diagnostic reasoning, treatment choices, and specific contextual challenges. By doing so, they offer valuable insights for healthcare providers and significantly enrich the growing body of knowledge regarding adolescent gynaecological health.\u003c/p\u003e\n\u003ch3\u003ePATIENT PERSEPCTIVE\u003c/h3\u003e\n\u003cp\u003eThe patient and her parents conveyed a sense of relief after observing an improvement in her condition and expressed gratitude for the prompt medical attention they received. They highlighted that this experience heightened their understanding of menstrual health and underscored the significance of seeking medical assistance promptly in cases of abnormal bleeding. Furthermore, the family indicated their openness to having this case published to assist in raising awareness for other families encountering similar difficulties.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e None declared\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors express their heartfelt appreciation to the Department of Obstetrics and Gynaecology, along with the clinical team engaged in the patient\u0026apos;s care, for their invaluable support and collaboration in managing this case. We also wish to convey our thanks to the patient and her family for their cooperation and consent, as this report would not have been feasible without their involvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eSai Krishna Reddy Konda gathered patient information, conducted a review of the literature, and helped in the preparation of the manuscript. Dr. Pavan Kumar Yanamadala conceived the study, oversaw the clinical analysis, and thoroughly revised the manuscript for its intellectual content. Geetanjali Katta aided in literature support. Prof. Rama Rao Nadendla offered academic oversight, direction, and granted final approval for the version intended for publication. All authors have reviewed and consented to the final manuscript and accept responsibility for its content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePATIENT CONSENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was secured from the legal guardian of the patient for the publication of this case report, along with any related details. Measures have been implemented to guarantee anonymity, and any identifying information has been omitted to safeguard the patient\u0026apos;s privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was deemed unnecessary for this case report in accordance with institutional policies and international guidelines, as it details the clinical course of a single patient without any experimental intervention. However, informed consent was secured, and the case has been documented in line with the established ethical standards for case reports.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKabra R, Fisher M. Abnormal uterine bleeding in adolescents. Current Problems in Pediatric and Adolescent Health Care [Internet]. 2022;52(5):101185. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/abs/pii/S1538544222000542?via%3Dihub\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/abs/pii/S1538544222000542?via%3Dihub\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCostlow L. Heavy menstrual bleeding in Adolescents: ACOG Management Recommendations [Internet]. AAFP. 2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aafp.org/pubs/afp/issues/2020/0515/p633.html\u003c/span\u003e\u003cspan address=\"https://www.aafp.org/pubs/afp/issues/2020/0515/p633.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHall EM, Ravelo AE, Aronoff SC, Del Vecchio MT. Systematic review and meta-analysis of the aetiology of heavy menstrual bleeding in 2,770 adolescent females. BMC Women S Health [Internet]. 2024;24(1). 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jamanetwork.com/journals/jamapediatrics/article-abstract/2757556\u003c/span\u003e\u003cspan address=\"https://jamanetwork.com/journals/jamapediatrics/article-abstract/2757556\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYadav A, Kaur H, Satyender. Evaluation of puberty menorrhagia in tertiary care centre. International Journal of Reproduction Contraception Obstetrics and Gynecology [Internet]. 2022;11(7):1914. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ijrcog.org/index.php/ijrcog/article/view/11758\u003c/span\u003e\u003cspan address=\"https://www.ijrcog.org/index.php/ijrcog/article/view/11758\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoker ETA, Kizilkan MP, Ersan FG, Akgul S, Aksu T, Aytac S et al. Heavy menstrual bleeding in adolescents: Evaluation of diagnostic indicators and treatment preferences. International Journal of Gynecology \u0026amp; Obstetrics [Internet]. 2024; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://obgyn.onlinelibrary.wiley.com/doi/\u003c/span\u003e\u003cspan address=\"https://obgyn.onlinelibrary.wiley.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ijgo.16132\u003c/span\u003e\u003cspan address=\"10.1002/ijgo.16132\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican College of Obstetricians and Gynecologists. Committee on Adolescent Health Care. Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG Committee Opinion 785. Obstet Gynecol. 2019;134(3):e71\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaradarajan R, Yoganarasimha S. Evaluation of cases of puberty menorrhagia requiring in-patient care. International Journal of Reproduction, Contraception, Obstetrics and Gynaecology [Internet]. 2022;11(7):1921. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ijrcog.org/index.php/ijrcog/article/view/11766\u003c/span\u003e\u003cspan address=\"https://www.ijrcog.org/index.php/ijrcog/article/view/11766\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManjunath MH, Aparna AB, Heena, Anil AM, Rahul RT, Ramita RS. Valuation of incidence prevalence, causes, diagnosis, and treatment of heavy menstrual bleeding in teenagers An Original Research. J Contemp Clin Pract. 2025;11(5):644\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.61336/jccp/25-05-91\u003c/span\u003e\u003cspan address=\"10.61336/jccp/25-05-91\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Avaialble from:.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRadhakrishnan A, Sharma N, Archunan PA. Menstrual challenges in puberty: Investigating menorrhagia in adolescent girls. Indian Journal of Obstetrics and Gynecology Research [Internet]. 2024;11(4):640\u0026ndash;6. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ijogr.org/archive/volume/11/issue/4/article/13745#article\u003c/span\u003e\u003cspan address=\"https://ijogr.org/archive/volume/11/issue/4/article/13745#article\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Menorrhagia, Adolescent Health, Anemia, Iron-Deficiency, Hypothalamic–Pituitary–Gonadal Axis, Tranexamic Acid, India","lastPublishedDoi":"10.21203/rs.3.rs-7508420/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7508420/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAbnormal uterine bleeding in adolescents (AUB-A) represents a prevalent gynaecological issue, with menorrhagia during puberty frequently occurring in the initial years following menarche. Although it is typically benign and associated with the immaturity of the hypothalamic–pituitary–ovarian axis, a late diagnosis can lead to significant anaemia and potentially life-threatening complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Details: \u003c/strong\u003eWe report a 14-year-old girl with 15 days of continuous vaginal bleeding, pallor, tachycardia, and hypotension. Lab tests showed a haemoglobin level of 2.1 g/dL, indicating iron deficiency anaemia. Coagulation and endocrine tests were normal, ruling out bleeding disorders and systemic causes. She was diagnosed with menorrhagia due to anovulatory cycles. Her treatment included intravenous tranexamic acid, norethisterone, iron supplements, methylprednisolone, and one unit of packed red blood cells. Over two weeks, her haemoglobin improved to 8.5 g/dL, and she stabilised clinically.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion: \u003c/strong\u003eThis case underscores the necessity for a thorough assessment of adolescent menorrhagia to rule out coagulopathies and endocrine disorders, in addition to the prompt implementation of evidence-based multimodal treatment. The degree of anaemia noted in this instance illustrates the consequences of late presentation, frequently influenced by sociocultural stigma and restricted access to healthcare in India.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eMenorrhagia during puberty necessitates careful clinical evaluation and prompt treatment to avert unnecessary health complications. Recording these instances aids in closing the gaps in the literature concerning adolescent gynaecology, particularly in resource-constrained environments.\u003c/p\u003e","manuscriptTitle":"Severe Puberty Menorrhagia Presenting With Life- Threatening Anemia in a 14-year-old Girl From Andhra Pradesh: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 09:39:44","doi":"10.21203/rs.3.rs-7508420/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-03T07:01:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-02T05:16:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-02T05:15:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-09-01T12:10:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"702e26c9-1682-4bf7-92de-5ac08ccf21b2","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-03T09:23:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 09:39:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7508420","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7508420","identity":"rs-7508420","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}