Indonesian traditional medicine or jamu is associated with increased estrogen levels and is often consumed for skin beautification and reproductive health (1). Endometrial polyps are rare among adolescents (2). We report an unusual case of endometrial polyps in an adolescent with significant hyperestrogenism. Parental written patient consent was obtained.
A 17-year-old girl presented with symptomatic anaemia secondary to prolonged heavy bleed. She had been consuming jamu. Clinically, she was pale with no other significant physical findings. Transabdominal ultrasonography (TAS) showed an endometrial thickness (ET) of 475mm (Figure 1). While other hormonal profiles were normal, her estradiol level was 3758 pmol/L. MRI demonstrated an increased ET raising concern for endometrial hyperplasia or malignancy (Figure 2). Jamu was halted and she received blood transfusions. Hysteroscopy examination demonstrated multiple polypoidal structures on the endometrial's right lateral wall. Histopathology examination revealed benign endometrial polyps. She was discharged well with cyclical progestogen. Subsequently, her menses were regular with normal ET and estradiol levels.
Hyperestrogenism causing thickened endometrial lining may be induced by jamu. Although rare, endometrial polyp should be one of the differential diagnoses for an adolescent presenting with heavy bleeding. Hysteroscopy remains the procedure of choice to rule out malignancy and relieve symptoms
Figure 1. Pelvic ultrasonography, sagittal view showing endometrial thickening of 4.75cm.
Figure 2. Contrast-enhanced CT pelvis, axial view at a lower section, showing endometrial thickening raising the concern for endometrial hyperplasia or malignancy
- 1. Listia, and Tripoli, Faruk and Wahyono, Bayu. Traditional medicine (Jamu) in modern medical discourse. The International Journal of Social Science 2015; 25: 55
- 2. Davis VJ, Dizon CD, Minuk CF. Rare cause of vaginal bleeding in early puberty. J Pediatr Adolesc Gynecol 2005; 18:113
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