Publication:

Treatment dilemma in an adolescent girl with idiopathic intracranial hypertension presenting with abnormal uterine bleeding and severe anemia

Abnormal uterine bleeding (AUB), specifically heavy menstrual bleeding (HMB) is a frequent complaint for adolescents. Idiopathic intracranial hypertension (IIH) is a syndrome of raised intracranial pressure, in the absence of any evidence of an intracranial space occupying lesion. Female sex, obesity and polycystic ovarian disease are known risk factors associated with IIH. This case report depicts the unusual case of an 18-year-old girl with IIH who presented with HMB for 28 days with severe anemia with Hb of 5.5 gm%. Urgent ophthalmic and neurological review was taken in view of IIH. Prompt treatment of AUB was done with blood transfusion, hemostatics, and orally administered iron supplements. Despite medical treatment for AUB, patient continued to bleed and hence after multidisciplinary discussion and informed consent she was started on low dose progesterone. Symptoms improved rapidly and she was discharged in a stable condition with tapering doses of medication and regular follow- up advice. Treatment of AUB in adolescents with IIH is a dilemma for physicians. To date, there is no direct evidence suggesting either implantable or oral contraceptives as a cause for IIH but few studies have closely linked oestrogen containing oral contraceptive pills and some levonorgestrel implants in IIH and hence these should be avoided.