Ovulation induction in young girls with menometrorragia: a safe and effective treatment

The prevalence of menometrorrhagia in fertile women is 11.4-13.2% and increases with aging. The presence of metrorrhagia is a relatively common cause of concern among adolescents and their parents, as well as a frequent cause of visits to emergency departments, gynaecologists, and pediatricians. Clomiphene is a selective estrogen receptor modulator (SERM) that increases the production of gonadotropins by inhibiting negative feedback on the hypothalamus. Clomiphene is primarily used in the treatment of female infertility for ovulation induction to reverse oligoovulation or anovulation, as occurs in polycystic ovary syndrome. Objective: The aim of our study was to evaluate the use of clomiphene citrate in ovulation induction, and therefore, in the cessation of bleeding in adolescents with menometrorrhagia in the absence of uterine, ovarian, or systemic pathologies. Design: Cohort study. Materials and methods: The study group was comprised of 50 subjects (age range, 13-16 years) with menometrorrhagia (bleeding >7 days in length with an average blood loss >80 ml). The treatment with clomiphene citrate at a dose of 50 mg/day for 5 days during the attack cycle, and from days 3 to 7 of three subsequent cycles, was offered to the patients. Results: After three cycles of therapy, all patients had resolution of the menometrorrhagia and resumption of ovulatory cycles. No patient reported unwanted side effects. Conclusion: We propose that low-dose clomiphene should be the first step in the treatment of adolescent dysfunctional bleeding (DUB).