Clinically apparent depression in an adolescent with heavy menstrual bleeding: a case report

Abstract

Heavy menstrual bleeding is a frequent occurrence among adolescent girls due to immaturity of the hypothalamic-pituitary-ovarian axis. Attending physicians usually focus on defining the aetiology and managing the medical complications, neglecting the psychosocial manifestations. We present the case of a 15-year-old teenager who presented with heavy menstrual bleeding requiring repeated blood transfusions. Assessment revealed florid psychosocial symptoms, diagnostic of adolescent major depression according to the diagnostic and statistical manual for mental disorders fifth edition. The patient was lost to follow-up during the COVID-19 pandemic; however, we hope to continue following her up for linkage with psychiatrists to make sure she is appropriately helped. This case is presented to illustrate the diagnostic and management gaps existent in adolescent girls with menstrual disorders. Longitudinal studies to further understand the psychosocial implications of heavy menstrual bleeding in adolescents are required. A holistic, concerted multi-disciplinary team approach is critical to successfully manage adolescent girls with heavy menstrual bleeding and attending clinicians must routinely incorporate assessment for psychosocial manifestations.

Keywords

• adolescent girls
• heavy menstrual bleeding
• psychosocial manifestations
• major depression