Ultra-low dose oral contraceptives: a game changer in managing puberty menorrhagia-a case series

Puberty menorrhagia, characterized by excessive menstrual bleeding during adolescence, often results from an immature hypothalamic-pituitary-ovarian axis. Effective management is crucial, yet compliance with traditional combined oral contraceptives (COCs) is often low due to side effects like nausea and breakthrough bleeding. This case series investigates the use of ultra-low dose COCs (ULDCOCs) containing 15µg ethinyl oestradiol and 60µg gestodene in five adolescents aged 13-16 years with puberty menorrhagia. The patients presented with prolonged bleeding, irregular cycles, and underlying conditions like polycystic ovarian syndrome (PCOS) and hypothyroidism. Treatment with ULDCOCs resulted in significant improvements: menstrual bleeding reduced, Pictorial Blood Assessment Chart (PBAC) scores dropped from a mean of 103 to 40, and haemoglobin levels improved. Common side effects included mild nausea, breast tenderness, and occasional breakthrough bleeding, which decreased over time. This series suggests that ULDCOCs provide effective cycle regulation and symptom relief with a favourable safety profile in adolescents with puberty menorrhagia. The reduced estrogen content offers fewer side effects while maintaining efficacy. Larger studies are warranted to confirm these findings and establish ULDCOCs as a standard treatment for adolescence-related menstrual disorders.