Tampon use in patients with anorexia nervosa can cause persistent vaginal bleeding: A case series

Authors

  • Jennifer L. Gaudiani MD,

    Corresponding author
    1. Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado
    2. Denver Health Medical Center, Denver, Colorado
    • University of Colorado Health Sciences Center, Denver, Colorado
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  • Gretchen Heinrichs MD,

    1. Department of Obstetrics and Gynecology, Denver Health and University of Colorado Health Sciences Center, Denver, Colorado
    2. University of Colorado Denver School of Medicine, Denver, Colorado
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  • Vignesh Narayanan MD,

    1. Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado
    2. Denver Health Medical Center, Denver, Colorado
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  • Philip S. Mehler MD

    1. Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado
    2. Department of Medicine, Denver Health Medical Center, Denver, Colorado
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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)

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