Abstract
Study Objective
Heavy menstrual bleeding (HMB) is a common gynecological complaint among young women
with up to 40% having experienced HMB. Bleeding disorders are increasingly being recognized
in adolescents and young adults with HMB. The aim of this study was to determine the
prevalence of bleeding disorders in adolescents with HMB, among patients who presented
to the Queensland Statewide Paediatric and Adolescent Gynaecology Service between
July 2007 and July 2017.
Design, Setting, Participants, Interventions, and Main Outcome Measures
The study was a retrospective review of 124 female adolescents aged 8 to 18 years
with HMB who presented to the Queensland Paediatric and Adolescent Gynaecology Service,
Brisbane, Australia. The primary outcome measure was diagnosis of a bleeding disorder,
with secondary outcomes including iron deficiency and/or anemia and treatment modalities.
Results
Screening for bleeding disorders was performed in 77/124 (62.1%) of patients with
HMB. Twenty-seven adolescents were diagnosed with a bleeding disorder, giving a prevalence
of 27/124 (21.7%) in those with HMB, and 27/77 (35%) with HMB who were screened. Of
these 35%, von Willebrand disease was the most common bleeding disorder, found in
14/27 (51.6%), followed by inherited platelet function disorders diagnosed in 9/27
(33.3%), thrombocytopenia (inherited or acquired) in 3/27 (11.1%), and Factor IX deficiency
in 1/27 (3.7%). Iron deficiency and/or anemia was diagnosed in 53/107 (49.5%) of patients
with HMB who were screened for this, and 19/27 (70.3%) of those diagnosed with a bleeding
disorder.
Conclusion
Adolescents with HMB who present to a tertiary pediatric and adolescent gynecology
service should be screened for bleeding disorders, because of the considerably high
prevalence in this at-risk population.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Bleeding disorders among young women: a population-based prevalence study.Acta Obstet Gynecol Scand. 2006; 85: 200
- Overview of bleeding disorders in adolescent females with menorrhagia.J Pediatr Adolesc Gynecol. 2010; 23: S15
- Menorrhagia in adolescents with inherited bleeding disorders.J Pediatr Adolesc Gynecol. 2010; 23: 215
- Menstrual bleeding patterns and prevalence of bleeding disorders in a multidisciplinary adolescent haematology clinic.Haemophilia. 2013; 19: 71
- Platelet function defects in adolescents with heavy menstrual bleeding.Haemophilia. 2014; 20: 249
- Frequency of inherited bleeding disorders in women with menorrhagia.Lancet. 1998; 14: 485
- Novel insights into the clinical phenotype and pathophysiology underlying low VWF levels.Blood. 2017; 130: 2344
- The diagnosis and management of von Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haematology.Br J Haematol. 2014; 167: 453
- Diagnosis of inherited platelet function disorders: guidance from the SSC of the ISTH.J Thromb Haemost. 2015; 13: 314
- Guidelines for the management of hemophilia.Haemophilia. 2013; 19: e1
- Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding.Haemophilia. 2012; 19: 225
- More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders.Haemophilia. 2005; 11: 295
- Assessment of menstrual blood loss using a pictorial chart.Br J Obstet Gynaecol. 1990; 97: 734
- Prospective evaluation of a pediatric bleeding questionnaire and the ISTH bleeding assessment tool in children and parents in routine clinical practice.J Thromb Haemost. 2012; 10: 1335
- Evaluation of the diagnostic utility for von Willebrand disease of a pediatric bleeding questionnaire.J Thromb Haemost. 2009; 7: 1418
- ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders.J Thromb Haemost. 2010; 8: 2063
- The evolution and value of bleeding assessment tools.J Thromb Haemost. 2012; 10: 2223
- Identifying Children with Hereditary Coagulation disorders (iCHEC): a protocol for a prospective cohort study.BMJ Open. 2018; 8: e020686
- Comparative study of the prevalence of clotting factor deficiency in carriers of haemophilia A and haemophilia B.Haemophilia. 2017; 23: e471
- Guidelines for the laboratory investigation of heritable disorders of platelet function.Br J Haematol. 2011; 155: 30
- Ristocetin-induced platelet aggregation (RIPA) and RIPA mixing studies.Methods Mol Biol. 2017; 1646: 473
- Aging and ABO blood type influence von Willebrand factor and factor VIII levels through interrelated mechanisms.J Thromb Haemost. 2016; 14: 953
- Can von Willebrand disease be investigated on combined hormonal contraceptives?.J Pediatr Adolesc Gynecol. 2013; 26: 138
- Von Willebrand disease type 1: a diagnosis in search of a disease.Blood. 2003; 101: 2089
- The rare inherited coagulation disorders.Pediatr Blood Cancer. 2013; 60: S37
- Treatment modalities in adolescents who present with heavy menstrual bleeding.J Pediatr Adolesc Gynecol. 2018; 31: 451
- Hematological considerations and management of adolescent girls with heavy menstrual bleeding and anemia in US children’s hospitals.J Pediatr Adolesc Gynecol. 2018; 31: 247
- Heavy menstrual bleeding in adolescents. NASPAG Committee Opinion.J Pediatr Adolesc Gynecol. 2017; 30: 335
- Reproductive Endocrinology.in: Hoffman B. Schorge J. Bradshaw K. Halvorson L. Schaffer J. Corton M. Williams Gynaecology. 3rd ed. McGraw-Hill, New York, NY2016
- Levonorgestrel-releasing intrauterine device use in female adolescents with heavy menstrual bleeding and bleeding disorders: single institution review.J Pediatr Adolesc Gynecol. 2017; 30: 479
- Antifibrinolytics for heavy menstrual bleeding.Cochrane Database Syst Rev. 2018; 4: CD000249
- Desmopressin (DDAVP) in the management of patients with congenital bleeding disorders.Haemophilia. 2014; 20: 158
- Assessment and validation of a defined fluid restriction protocol in the use of subcutaneous desmopressin for children with inherited bleeding disorders.Haemophilia. 2016; 22: 700
- Correcting iron deficiency.Aust Prescr. 2016; 39: 193
Article info
Publication history
Published online: November 22, 2018
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology. All rights reserved.
