Post-menopausal vaginal bleeding causing severe anemia due to leech infestation: a case report

Leech infestation in a 60-year-old post-menopausal woman caused vaginal bleeding and severe anemia. This case report documents the removal of the leeches, cessation of vaginal bleeding, and subsequent clinical improvement.

A 60-year-old para 7 post-menopausal woman presented with severe anemia secondary to postmenopausal vaginal bleeding lasting 2 weeks. Two leeches - one periurethral and one vaginal - were identified and removed following normal saline irrigation. She received five units of whole blood, resulting in an asymptomatic post-procedure course.

Vaginal leech infestation is rare but still occurs in low-resource countries such as Ethiopia. When it occurs, it is usually in young women; however, in this case report, we present a 60-year-old post-menopausal woman. Additionally, infestation with two leeches is another fascinating and extremely rare finding. A high index of suspicion is critical in patients with vaginal bleeding and a history of river water exposure.

Since vaginal leech infestation can lead to postmenopausal vaginal bleeding and associated morbidities, it is important to maintain a suspicion for leech infestation as a cause in resource-limited countries, regardless of age.