Analysis of causes and management of pubertal menorrhagia requiring hospitalization

Background: Puberty menorrhagia, characterized by excessive menstrual bleeding in adolescents between menarche and 19 years of age, poses a significant clinical challenge. It frequently results from an immature hypothalamic-pituitary-ovarian (HPO) axis but may also indicate underlying systemic or endocrine disorders. Prompt evaluation and management are critical to preventing anaemia and long-term reproductive health issues. To assess the clinical presentations, etiological factors and treatment outcomes of adolescent girls presenting with puberty menorrhagia in a tertiary care setting. Methods: A retrospective record-based study was conducted in the Department of Obstetrics and Gynaecology, Mysore Medical College and Research Institute, from January 2019 to December 2023. Data from 80 adolescent girls aged between menarche and 19 years, who were admitted for the management of menorrhagia, were analysed. Clinical parameters, laboratory investigations including haemoglobin, thyroid profile, pelvic ultrasound findings and treatment modalities were reviewed. Results: The majority of cases (40%) were in the 15–17-years age group, with 55% attaining menarche between 12–14 years. Most presentations occurred within 6 months of symptom onset. Anaemia was prevalent, with 43.75% having moderate and 17.5% severe anaemia. The most common presenting symptom was heavy menstrual bleeding alone (65%). Ultrasound findings were normal in 72.5%, with PCOS being the most common abnormality. Hypothyroidism was noted in 24.25% of cases. The primary treatment modality was parenteral iron and blood transfusion (67.5%), while hormonal therapy was administered to 32.5% of patients. Conclusions: Puberty menorrhagia is predominantly due to anovulatory cycles associated with HPO axis immaturity. Early recognition and individualized management, including correction of anaemia and hormonal regulation, are essential to prevent long-term morbidity. Strengthening adolescent health education and ensuring consistent follow-up remain critical components of care.