High‐Dose Medroxyprogesterone Acetate for the Treatment of Dysfunctional Uterine Bleeding in 24 Adolescents

EDITORIAL COMMENT": This classic study presents a very large experience of successful treatment of adolescent women with severe dysfunctional uterine bleeding all of whom responded to high‐dose oral medroxyprogesterone acetate therapy. It is interesting to note that none of these patients had underlying haematological disorders such as idiopathic thrombocytopenic purpura or Von Willebrand disease. In the editor's experience at least 1 such case would be expected in a series of 24 patients with adolescent dysfunctional uterine bleeding requiring hospitalization because of anaemia. The authors have not told us the further management or results of follow‐up of these patients. The editorial subcommittee considers that patients with severe dysfunctional bleeding should, after control of the presenting episode of bleeding, be given a 3–6 month course of either a low‐dose oral contraceptive pill or progestogen therapy for the last 18 days of the menstrual cycle; follow‐up is then necessary to check that menstrual function was normal and that anaemia had not recurred. These patients also warrant oral iron therapy during this interval. It is noteworthy that none of these 24 patients had demonstrable endometrial pathology with abdominal ultrasonography and none of them required curettage. Authors'Response to Editorial Comment: Our study group was purposely selected as adolescents with severe dysfunctional uterine bleeding without an underlying haematological disorder. We agree that one would expect to see such a case in a series of 24 adolescents with dysfunctional uterine bleeding sufficient to warrant admission to hospital. Our follow‐up regimen was the same as mentioned in the Editorial Comment and none of the 24 patients returned with the same complaint. Summary: The objective of the study was to evaluate the effectiveness of high‐dose oral medroxyprogesterone acetate therapy in the management of excessive dysfunctional uterine bleeding in adolescents. The study group consisted of 24 adolescents who were hospitalized with the diagnosis of excessive uterine bleeding and anaemia. Oral medroxyprogesterone acetate tablets were administered at a total dose of 60–120 mg during the first day of admission and 20 mg per day for the following 10 days. The blood loss was reduced to acceptable levels in all patients, and actually stopped in 6 (25%) within the first 24 hours of the treatment; bleeding ceased in 29.2%, 20.8% and 25% on the second, third and fourth days respectively. Significant correlation was identified between the initial haemoglobin concentration and the time required for cessation of bleeding (r=0.5, p=0.001). Rapid saturation of the endometrium with progestogens seems to be an highly effective mode of treatment for excessive dysfunctional uterine bleeding in adolescents.