A 14-year-old girl presents with heavy, irregular periods since menarche 18 months ago. She bleeds for 10-14 days every 3-6 weeks. Hemoglobin is 9.8 g/dL. Pelvic ultrasound is normal. Coagulation studies are normal. What is the most likely underlying mechanism?

• A Luteal phase defect
• B Coagulopathy
• C Endometrial polyp
• D Anovulation due to immature hypothalamic-pituitary-ovarian axis ✓

Explanation

Anovulatory bleeding is common in the first 2-3 years after menarche due to immaturity of the hypothalamic-pituitary-ovarian axis, resulting in unopposed estrogen stimulation and irregular shedding. Normal coagulation studies exclude coagulopathy. Luteal phase defect causes premenstrual spotting, not heavy prolonged bleeding. Endometrial polyps are rare in adolescents.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.