Background: Endometrial polyps are exceptionally rare in adolescents, in whom heavy menstrual bleeding (HMB) is usually due to anovulatory cycles or coagulation disorders. Optimal postoperative management in this age group, particularly regarding recurrence prevention, remains unclear. Case: A 14-year-old girl presented with persistent HMB unresponsive to combined estrogen–progestin therapy. Laboratory tests showed no coagulation or endocrine abnormalities. Imaging revealed an endometrial mass extending into the cervical canal, and hysteroscopic resection confirmed a benign endometrial polyp. Given her anovulatory background and presumed unopposed estrogen exposure, postoperative treatment with a low-dose combined oral contraceptive (COC) was initiated. Over a 3-year follow-up, regular cycles were maintained without recurrence. Conclusion: Structural causes of HMB, such as endometrial polyps or other organic uterine lesions, should be considered when adolescents remain symptomatic despite hormonal therapy. COCs may serve as an effective postoperative strategy to prevent the recurrence of estrogen-dependent lesions such as endometrial polyps in patients with persistent anovulatory cycles.
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