Original Study| Volume 32, ISSUE 2, P122-127, April 2019

Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding: The Queensland Statewide Paediatric and Adolescent Gynaecology Service

Published:November 22, 2018DOI:


      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.


      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.


      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 access
      One-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 to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • 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
        • Chi C.
        • Pollard D.
        • Tuddenham E.G.
        • et al.
        Menorrhagia in adolescents with inherited bleeding disorders.
        J Pediatr Adolesc Gynecol. 2010; 23: 215
        • 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
        • Mills H.L.
        • Abdel-Baki M.S.
        • Teruya J.
        • et al.
        Platelet function defects in adolescents with heavy menstrual bleeding.
        Haemophilia. 2014; 20: 249
        • Kadir R.A.
        • Economides D.L.
        • Sabin C.A.
        • et al.
        Frequency of inherited bleeding disorders in women with menorrhagia.
        Lancet. 1998; 14: 485
        • Lavin M.
        • Aguila S.
        • Schneppenheim S.
        • et al.
        Novel insights into the clinical phenotype and pathophysiology underlying low VWF levels.
        Blood. 2017; 130: 2344
        • Laffan M.A.
        • Lester W.
        • O’Donnell J.S.
        • et al.
        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
        • Gresele P.
        Diagnosis of inherited platelet function disorders: guidance from the SSC of the ISTH.
        J Thromb Haemost. 2015; 13: 314
        • Srivastava A.
        • Brewer A.K.
        • Mauser-Bunschoten E.P.
        • et al.
        Guidelines for the management of hemophilia.
        Haemophilia. 2013; 19: e1
        • Wang W.
        • Bourgeois T.
        • Klima J.
        • et al.
        Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding.
        Haemophilia. 2012; 19: 225
        • James A.H.
        More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders.
        Haemophilia. 2005; 11: 295
        • 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
        • Bidlingmaier C.
        • Grote V.
        • Budde U.
        • et al.
        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
        • Bowman M.
        • Riddel J.
        • Rand M.L.
        • et al.
        Evaluation of the diagnostic utility for von Willebrand disease of a pediatric bleeding questionnaire.
        J Thromb Haemost. 2009; 7: 1418
        • Rodeghiero F.
        • Tosetto A.
        • Abshire T.
        • et al.
        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
        • Rydz N.
        • James P.D.
        The evolution and value of bleeding assessment tools.
        J Thromb Haemost. 2012; 10: 2223
        • Stokhuijzen E.
        • Rand M.L.
        • Cnossen M.H.
        • et al.
        Identifying Children with Hereditary Coagulation disorders (iCHEC): a protocol for a prospective cohort study.
        BMJ Open. 2018; 8: e020686
        • Boban A.
        • Lambert C.
        • Lannoy N.
        • et al.
        Comparative study of the prevalence of clotting factor deficiency in carriers of haemophilia A and haemophilia B.
        Haemophilia. 2017; 23: e471
        • Harrison P.
        • Mackie I.
        • Mumford A.
        • et al.
        Guidelines for the laboratory investigation of heritable disorders of platelet function.
        Br J Haematol. 2011; 155: 30
        • Frontroth J.P.
        • Favaloro E.J.
        Ristocetin-induced platelet aggregation (RIPA) and RIPA mixing studies.
        Methods Mol Biol. 2017; 1646: 473
        • Albanez S.
        • Ogiwara K.
        • Michels A.
        • et al.
        Aging and ABO blood type influence von Willebrand factor and factor VIII levels through interrelated mechanisms.
        J Thromb Haemost. 2016; 14: 953
        • Dumont T.
        • Allen L.
        • Kives S.
        Can von Willebrand disease be investigated on combined hormonal contraceptives?.
        J Pediatr Adolesc Gynecol. 2013; 26: 138
        • Sadler J.E.
        Von Willebrand disease type 1: a diagnosis in search of a disease.
        Blood. 2003; 101: 2089
        • Bolton-Maggs P.H.
        The rare inherited coagulation disorders.
        Pediatr Blood Cancer. 2013; 60: S37
        • Alaqzam T.S.
        • Stanley A.C.
        • Simpson P.M.
        • et al.
        Treatment modalities in adolescents who present with heavy menstrual bleeding.
        J Pediatr Adolesc Gynecol. 2018; 31: 451
        • Powers J.M.
        • Stanek J.R.
        • Srivaths L.
        • et al.
        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
        • Haamid F.
        • Sass A.E.
        • Dietrich J.E.
        Heavy menstrual bleeding in adolescents. NASPAG Committee Opinion.
        J Pediatr Adolesc Gynecol. 2017; 30: 335
      1. Reproductive Endocrinology.
        in: Hoffman B. Schorge J. Bradshaw K. Halvorson L. Schaffer J. Corton M. Williams Gynaecology. 3rd ed. McGraw-Hill, New York, NY2016
        • Adeyemi-Fowode O.A.
        • Santos X.M.
        • Dietrich J.E.
        • et al.
        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
        • Bryant-Smith A.
        • Lethaby A.
        • Farquhar C.
        • et al.
        Antifibrinolytics for heavy menstrual bleeding.
        Cochrane Database Syst Rev. 2018; 4: CD000249
        • Leissinger C.
        • Carcao M.
        • Gill J.C.
        • et al.
        Desmopressin (DDAVP) in the management of patients with congenital bleeding disorders.
        Haemophilia. 2014; 20: 158
        • Mason J.A.
        • Robertson J.D.
        • McCosker J.
        • et al.
        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
        • Baird-Gunning J.
        • Bromley J.
        Correcting iron deficiency.
        Aust Prescr. 2016; 39: 193