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

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.