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Heavy Menstrual Bleeding in Adolescents

Published:January 17, 2017DOI:https://doi.org/10.1016/j.jpag.2017.01.002

      Abstract

      Heavy menstrual bleeding (HMB) is a very common gynecological condition in female adolescents and a frequent presenting complaint of those with bleeding disorders. Recommendations have been established to screen for bleeding disorders in this age group where appropriate. The purpose of this document is to impart clinical recommendations regarding HMB in adolescents. Specifically, in this article we provide a description of the epidemiology, clinical presentation, diagnostic approach, and treatment of HMB in adolescents.

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      References

        • Munro M.G.
        • Critchley H.O.
        • Fraser I.S.
        The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them?.
        Am J Obstet Gynecol. 2012; 207: 259
        • Friberg B.
        • Orno A.K.
        • Lindgren A.
        • et al.
        Bleeding disorders among young women: a population-based prevalence study.
        Acta Obstet Gynecol Scand. 2006; 85: 200
        • Ahuja S.P.
        • Hertweck S.P.
        Overview of bleeding disorders in adolescent females with menorrhagia.
        J Pediatr Adolesc Gynecol. 2010; 23: S15
        • James A.H.
        Bleeding disorders in adolescents.
        Obstet Gynecol Clin North Am. 2009; 36: 153
        • Claessens E.A.
        • Cowell C.A.
        Acute adolescent menorrhagia.
        Am J Obstet Gynecol. 1981; 139: 277
        • Smith Y.R.
        • Quint E.H.
        • Hertzberg R.B.
        Menorrhagia in adolescents requiring hospitalization.
        J Pediatr Adolesc Gynecol. 1998; 11: 13
        • Oral E.
        • Cagdas A.
        • Gezer A.
        • et al.
        Hematological abnormalities in adolescent menorrhagia.
        Arch Gynecol Obstet. 2002; 266: 72
        • Bevan J.A.
        • Maloney K.W.
        • Hillery C.A.
        • et al.
        Bleeding disorders: a common cause of menorrhagia in adolescents.
        J Pediatr. 2001; 138: 856
        • Philipp C.S.
        • Faiz A.
        • Dowling N.
        • et al.
        Age and the prevalence of bleeding disorders in women with menorrhagia.
        Obstet Gynecol. 2005; 105: 61
        • Jayasinghe Y.
        • Moore P.
        • Donath S.
        • et al.
        Bleeding disorders in teenagers presenting with menorrhagia.
        Aust N Z J Obstet Gynaecol. 2005; 45: 439
        • Mikhail S.
        • Varadarajan R.
        • Kouides P.
        The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre.
        Haemophilia. 2007; 13: 627
        • Chi C.
        • Pollard D.
        • Tuddenham E.G.
        • et al.
        Menorrhagia in adolescents with inherited bleeding disorders.
        J Pediatr Adolesc Gynecol. 2010; 23: 215
        • Popat V.B.
        • Prodanov T.
        • Calis K.A.
        • et al.
        The menstrual cycle - a biological marker of general health in adolescents.
        Ann N Y Acad Sci. 2008; 1135: 43
        • Biro F.M.
        Puberty.
        Adolesc Med. 2007; 18: 425
        • Neinstein L.S.
        • Katzman D.
        • Callahan T.
        Neinstein's Adolescent and Young Adult Health Care: A Practical Guide.
        6th ed. Lippincott Williams and Wilkins, Philadelphia, Pennsylvania, 2016
        • Revel-Vilk S.
        • Paltiel O.
        • Lipschuetz M.
        • et al.
        Underdiagnosed menorrhagia in adolescents is associated with underdiagnosed anemia.
        J Pediatr. 2012; 160: 468
        • Dietrich J.E.
        • Tran X.G.
        • Giardino A.P.
        Bleeding disorder education in obstetrics and gynecology residency training: a national survey.
        J Pediatr Adolesc Gynecol. 2011; 24: 94
        • ACOG Committee on Practice Bulletins–Gynecology
        American College of Obstetricians and Gynecologists. ACOG practice bulletin: management of anovulatory bleeding.
        Int J Gynaecol Obstet. 2001; 72: 263
        • Hallberg L.
        • Hogdahl A.M.
        • Nilsson L.
        • et al.
        Menstrual blood loss and iron deficiency.
        Acta Med Scand. 1966; 180: 639
        • Hallberg L.
        • Hogdahl A.M.
        • Nilsson L.
        • et al.
        Menstrual blood loss–a population study. Variation at different ages and attempts to define normality.
        Acta Obstet Gynecol Scand. 1966; 45: 320
        • American Academy of Pediatrics Committee on Adolescence
        • American College of Obstetricians and Gynecologists Committee on Adolescent Health Care
        • Diaz A.
        • et al.
        Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
        Pediatrics. 2016; 137: 1
        • World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls
        II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World Health Organization Task Force on Adolescent Reproductive Health.
        J Adolesc Health Care. 1986; 7: 236
        • Treloar A.E.
        • Boynton R.E.
        • Behn B.G.
        • et al.
        Variation of the human menstrual cycle through reproductive life.
        Int J Fertil. 1967; 12: 77
        • Vollman R.F.
        The menstrual cycle.
        Major Probl Obstet Gynecol. 1977; 7: 1
        • Widholm O.
        • Kantero R.L.
        A statistical analysis of the menstrual patterns of 8,000 Finnish girls and their mothers.
        Acta Obstet Gynecol Scand Suppl. 1971; 14: 11
        • Flug D.
        • Largo R.H.
        • Prader A.
        Menstrual patterns in adolescent Swiss girls: a longitudinal study.
        Ann Hum Biol. 1984; 11: 495
        • Pitangui A.C.
        • Gomes M.R.
        • Lima A.S.
        • et al.
        Menstruation disturbances: prevalence, characteristics, and effects on the activities of daily living among adolescent girls from Brazil.
        J Pediatr Adolesc Gynecol. 2013; 26: 148
        • Matteson K.A.
        • Raker C.A.
        • Clark M.A.
        • et al.
        Abnormal uterine bleeding, health status, and usual source of medical care: analyses using the Medical Expenditures Panel Survey.
        J Womens Health (Larchmt). 2013; 22: 959
        • Pawar A.
        • Krishnan R.
        • Davis K.
        • et al.
        Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders.
        Haemophilia. 2008; 14: 579
        • Kulkarni R.
        Improving care and treatment options for women and girls with bleeding disorders.
        Eur J Haematol. 2015; 95: 2
        • Jensen J.T.
        • Lefebvre P.
        • Laliberte F.
        • et al.
        Cost burden and treatment patterns associated with management of heavy menstrual bleeding.
        J Womens Health (Larchmt). 2012; 21: 539
        • Cote I.
        • Jacobs P.
        • Cumming D.C.
        Use of health services associated with increased menstrual loss in the United States.
        Am J Obstet Gynecol. 2003; 188: 343
        • Janssen C.A.
        • Scholten P.C.
        • Heintz A.P.
        A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss.
        Obstet Gynecol. 1995; 85: 977
        • Reid P.C.
        • Coker A.
        • Coltart R.
        Assessment of menstrual blood loss using a pictorial chart: a validation study.
        BJOG. 2000; 107: 320
        • Higham J.M.
        • O’Brien P.M.
        • Shaw R.W.
        Assessment of menstrual blood loss using a pictorial chart.
        Br J Obstet Gynaecol. 1990; 97: 734
        • Sanchez J.
        • Andrabi S.
        • Bercaw J.L.
        • et al.
        Quantifying the PBAC in a pediatric and adolescent gynecology population.
        Pediatr Hematol Oncol. 2012; 29: 479
        • Warner P.E.
        • Critchley H.O.
        • Lumsden M.A.
        • et al.
        Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data.
        Am J Obstet Gynecol. 2004; 190: 1216
        • Wang W.
        • Bourgeois T.
        • Klima J.
        • et al.
        Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding.
        Haemophilia. 2013; 19: 225
        • Munro M.G.
        • Critchley H.O.
        • Broder M.S.
        • et al.
        FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.
        Int J Gynaecol Obstet. 2011; 113: 3
        • Wilkinson J.P.
        • Kadir R.A.
        Management of abnormal uterine bleeding in adolescents.
        J Pediatr Adolesc Gynecol. 2010; 23: S22
        • Committee on Practice Bulletins—Gynecology
        Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women.
        Obstet Gynecol. 2012; 120: 197
        • James A.H.
        • Kouides P.A.
        • Abdul-Kadir R.
        • et al.
        Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel.
        Eur J Obstet Gynecol Reprod Biol. 2011; 158: 124
        • Bennett A.R.
        • Gray S.H.
        What to do when she’s bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents.
        Curr Opin Pediatr. 2014; 26: 413
        • Hart R.
        • Doherty D.A.
        The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage.
        J Clin Endocrinol Metab. 2015; 100: 911
        • Emans S.J.
        • Laufer M.R.
        Emans, Laufer, Goldstein's Pediatric & Adolescent Gynecology.
        6th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins Health, Philadelphia2011
        • Knol H.M.
        • Mulder A.B.
        • Bogchelman D.H.
        • et al.
        The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities.
        Am J Obstet Gynecol. 2013; 209: 202.e201
        • Vo K.T.
        • Grooms L.
        • Klima J.
        • et al.
        Menstrual bleeding patterns and prevalence of bleeding disorders in a multidisciplinary adolescent haematology clinic.
        Haemophilia. 2013; 19: 71
        • Seravalli V.
        • Linari S.
        • Peruzzi E.
        • et al.
        Prevalence of hemostatic disorders in adolescents with abnormal uterine bleeding.
        J Pediatr Adolesc Gynecol. 2013; 26: 285
        • Sokkary N.A.
        • Venkateswaran L.
        • Dietrich J.E.
        • et al.
        Platelet function disorders and menorrhagia in adolescents: a review of laboratory diagnosis.
        J Pediatr Adolesc Gynecol. 2012; 25: 233
        • Mills H.L.
        • Abdel-Baki M.S.
        • Teruya J.
        • et al.
        Platelet function defects in adolescents with heavy menstrual bleeding.
        Haemophilia. 2014; 20: 249
        • James A.H.
        • Manco-Johnson M.J.
        • Yawn B.P.
        • et al.
        Von Willebrand disease: key points from the 2008 National Heart, Lung, and Blood Institute guidelines.
        Obstet Gynecol. 2009; 114: 674
        • Kistangari G.
        • McCrae K.R.
        Immune thrombocytopenia.
        Hematol Oncol Clin North Am. 2013; 27: 495
        • Rajpurkar M.
        • O’Brien S.H.
        • Haamid F.W.
        • et al.
        Heavy menstrual bleeding as a common presenting symptom of rare platelet disorders: illustrative case examples.
        J Pediatr Adolesc Gynecol. 2016; 29: 537
        • Kouides P.A.
        • Conard J.
        • Peyvandi F.
        • et al.
        Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding.
        Fertil Steril. 2005; 84: 1345
        • American College of Obstetricians and Gynecologists
        ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women.
        Obstet Gynecol. 2013; 121: 891
        • Kirtava A.
        • Drews C.
        • Lally C.
        • et al.
        Medical, reproductive and psychosocial experiences of women diagnosed with von Willebrand’s disease receiving care in haemophilia treatment centres: a case-control study.
        Haemophilia. 2003; 9: 292
        • Silwer J.
        von Willebrand’s disease in Sweden.
        Acta Paediatr Scand Suppl. 1973; 238: 1
        • Anstey A.
        • Mayne K.
        • Winter M.
        • et al.
        Platelet and coagulation studies in Ehlers-Danlos syndrome.
        Br J Dermatol. 1991; 125: 155
        • Kaplinsky C.
        • Kenet G.
        • Seligsohn U.
        • et al.
        Association between hyperflexibility of the thumb and an unexplained bleeding tendency: is it a rule of thumb?.
        Br J Haematol. 1998; 101: 260
        • Moroni R.M.
        • Vieira C.S.
        • Ferriani R.A.
        • et al.
        Presentation and treatment of uterine leiomyoma in adolescence: a systematic review.
        BMC Womens Health. 2015; 15: 4
        • Wright K.N.
        • Laufer M.R.
        Leiomyomas in adolescents.
        Fertil Steril. 2011; 95: 2434.e2415
        • Bradley L.D.
        • Gueye N.A.
        The medical management of abnormal uterine bleeding in reproductive-aged women.
        Am J Obstet Gynecol. 2016; 214: 31
        • Mullins T.L.
        • Miller R.J.
        • Mullins E.S.
        Evaluation and management of adolescents with abnormal uterine bleeding.
        Pediatr Ann. 2015; 44: e218
        • Venkateswaran L.
        • Dietrich J.E.
        Gynecologic concerns in pubertal females with blood disorders.
        J Pediatr Adolesc Gynecol. 2013; 26: 80
        • Centers for Disease Control and Prevention (CDC)
        U S. Medical eligibility criteria for contraceptive use, 2010.
        MMWR Recomm Rep. 2010; 59: 1
        • Santos M.
        • Hendry D.
        • Sangi-Haghpeykar H.
        • et al.
        Retrospective review of norethindrone use in adolescents.
        J Pediatr Adolesc Gynecol. 2014; 27: 41
        • Sokkary N.
        • Dietrich J.E.
        Management of heavy menstrual bleeding in adolescents.
        Curr Opin Obstet Gynecol. 2012; 24: 275
        • Srivaths L.V.
        • Dietrich J.E.
        • Yee D.L.
        • et al.
        Oral tranexamic acid versus combined oral contraceptives for adolescent heavy menstrual bleeding: a pilot study.
        J Pediatr Adolesc Gynecol. 2015; 28: 254
        • Halimeh S.
        Menorrhagia and postpartum haemorrhage in women with rare bleeding disorder.
        Thromb Res. 2015; 135: S34-S37

      Linked Article

      • Erratum
        Journal of Pediatric and Adolescent GynecologyVol. 30Issue 6
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          Due to a coding error, the article, “Heavy Menstrual Bleeding in Adolescents,” by Haamid F, Sass AE, and Dietrich JE (J Pediatr Adolesc Gynecol 30 (3): pp 335–340, 2017; DOI: http://dx.doi.org/10.1016/j.jpag.2017.01.002 ) was published as a mini-review and not a NASPAG Committee Opinion. As a result appropriate acknowledgements were not as prominently displayed. An updated and corrected version of the article now appears online.
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