SEARCH

SEARCH BY CITATION

Keywords:

  • amenorrhea;
  • vaginal bleeding;
  • hormones;
  • estrogen

Abstract

Objective:

To describe the phenomenon of persistent vaginal bleeding intwo patients with severe anorexia nervosa.

Method:

We report two cases of young women with severe anorexia nervosa reporting vaginal bleeding that persisted for months despite trials of topical and systemic conjugated estrogen therapy.

Result:

A speculum exam by a gynecologist ultimately revealed the source of the bleeding to be tampon-induced vaginal ulcers. These resolved, along with the vaginal bleeding, with vaginal estrogen cream and cessation of tampon use.

Discussion:

Most patients with anorexia nervosa are amenorrheic due to reversion of the hypothalamic-pituitary-ovarian axis to a prepubertal state. Vaginal bleeding in patients with anorexia nervosa may trigger needless systemic hormonal treatments, radiographic studies, and multiple physician visits. A careful exam is warranted to evaluate for the presence of tampon-induced vaginal ulcer in patients with anorexia nervosa who have persistent vaginal bleeding. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2010)