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In a case series, five girls were described [not all ages to reaction onsets stated], who developed vaginal bleeding due to overdose of estradiol valerate or estrogen or estradiol [not all durations of treatments to reactions onset and outcomes stated].
Patient 1: The girl, who had a history of turner syndrome mosaic karyotype was planned to start on treatment with estrogen replacement therapy for hypogonadism at the age of 14.9 years. Therefore, a letter was written to the general practitioners to prescribe her ethinylestradiol 2pg daily. Six months later, she reported frequent periods with breakthrough vaginal bleeding, in association with significant mood swings. Investigation revealed that she had been receiving estradiol valerate 2mg [Zumenon] daily for 6 months. Therefore, the estradiol treatment was discontinued for 2 weeks and she was prescribed with ethinylestradiol 2pg daily and she remained uneventful.
Patient 2: The girl with a significant history of hypopituitarism was started on treatment with estrogen replacement therapy for hypogonadism with ethinylestradiol 2gg daily at the age of 13.3 years. Six months later, her ethinylestradiol dose was increased to 5pg daily. However, she erroneously received 2 x 2gg tablets of ethinylestradiol and tablet of estradiol [1 7 ß estradiol] 1 mg for 6 weeks. She reported some vaginal bleeding. Once the mistake was noticed she was recommenced on ethinylestradiol 6gg.
Patient 3: The girl, who had a history of Turner syndrome with no ovarian tissue was planned to start on estrogen replacement for hypogonadism at the age of 14.5 years. Due to a transcription error in a letter, she started receiving estradiol valerate 2mg daily [Zumenon] instead of ethinylestradiol 2pg daily. Three months later, she was reported to have frequent, protracted, heavy periods. Therefore, her estrogen therapy was discontinued and she was uneventfully restarted on ethinylestradiol 5gg daily.
Patient 4: The girl, who had a history of multiple pituitary hormone deficiencies was started on estrogen replacement therapy with ethinylestradiol 2pg daily for hypogonadism at the age of 12.5 years. However, she received estradiol valerate 2mg for two and a half months following a dispensing error. Once the error was noticed she was switched to ethinylestradiol 2pg. Subsequently, she experienced some vaginal spotting for a week.
Patient 5: The girl with beta-thalassaemia major was started on ethinylestradiol 2pg daily for hypogonadism. She was also receiving chelation therapy. At the age of 13.5 years, she received estrogen 1mg a day for 2 months along with her prescribed ethinylestradiol 5pg daily. Consequently, she experienced two cycles of vaginal bleeding with subsequent breakthrough bleeding when the ethinylestradiol was increased to 10pg a day.
Author comment: "We report five cases of iatrogenic vaginal bleeding due to incorrect prescribing of estradiol in young female hypogonadal patients."
Kirk JMW, et al. Estradiol: Micrograms or milligrams. Endocrinology, Diabetes and Metabolism Case Reports 2016: 2016. Available from: URL: http:// doi.org/10.1530/EDM-15-0096 - United Kingdom 803233377
Copyright Springer Science & Business Media Apr 1, 2017