MEDizzy - A 16-year-old woman comes to your office complaining of

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Acute Complaints

A 16-year-old woman comes to your office complaining of unpredictable menstrual periods. She began her periods at age 14 and they have never been predictable. She denies sexual activity in her lifetime, has no systemic illness, uses no medications regularly, and her physical examination is normal. Which of the following is her most likely diagnosis?

ExplanationAnovulatory bleeding is caused by continuous unopposed endometrial estrogen stimulation. Since these patients do not ovulate, progesterone from the corpus luteum is not secreted, the withdrawal from which would normally cause endometrial sloughing. When women are within 2 years of menarche, this is especially common, and can be followed expectantly. Alternatively, oral contraceptives can be used to regulate periods. Pregnancy should be ruled out, even in women who deny sexual activity. Ovulatory bleeding due to fluctuations in estrogen and progesterone levels is also a cause of abnormal bleeding, but accounts for only about 10% of cases. Leiomyomas and polyps may cause bleeding, but usually not in this age group.