<prompt> MC cause of Puberty Menorrhagia:AnovulationMalignancyEndometriosisBleeding disorder  <response>: Ans-A Anovulation Ref Shaw 14th 271; Novak 14th447- 449 ; COGDT 10th 557Puberty Menorrhagia Pubertymenorrhagia is a threshold of bleeding of adolescence caused by: Excess or unopposed estrogen absence of progesterone in the anovulatory cycles- most common. Coagulation disorders 20 Menorrhagia may be noticed from the very start of menarche, but often, the initial few periods are normalPuberty menorrhagia is excessive cyclical regular bleeding occurring in adolescents. Most common cause of puberty menorrhagia is anovulation which results in excess of estrogen or unopposed estrogen in absence of progesterone, and the most common cause is- Bleeding disorders- blood dyscrasias and coagulation disorders- Shaw 14th 271Other Cause of Abnormal Bleeding in Adolescents. Novak 14th 447- 449 Pregnancy-related bleeding Sexually transmitted- Infections - particularly chlamydia Sexual abuse Hepatic dysfunction Hyperprolactinemia it can cause either amenorrhea or irregular bleeding PCOS- It can occur during adolescence also Hypothyroidism Anatomical cause - Partially obstructive genetic anomalies.Table: Shaw 14th271DUB is of two type1. Anovulatory 802. Ovulatory 20Anovulatory 801. Threshold bleeding of puberty menorrhagia2. Metropathia hemorrhagia- cystic glandular hyperplasia3. Premenopausal DUB Atrophy of endometrium.Ovulatory 201. Irregular ripening2. Irregular shedding3. IUCD insertion4. Following the sterilization operation.Anovulatory Bleeding Treatment Novak 14th 451-54, COGDT 10th557Mild bleedingHematinicsReassuranceHormone therapy lowDose OCFS or cyclical progesterone therapy Medroxyprogesterone acetate 5- 10mgday for 10-13 days.Moderate bleedingCombination monophask OC P every 6 hrs. for 4-7 days and then stop followed byWithdrawl bleeding followed byLow dose OCP for 3 to 6 by cycles Acute severe bleedingEmergency management:Admit the patientStabilize the vitalsConjugated estrogen 25 -40mg LV every 6 hrs or 2.5mg oral estrogen every 6hrs.Once bleeding stops medroxy progesterone l0mg for 10 days if above regime is not effectively assessed the patient for any local cause. USG should be done to rule out fibroidendometrial hyperplasia or clots.It intrauterine clots are detected D C should be done. 