Abstract
Study Objective
Although multiple hormonal treatment strategies are effective in decreasing heavy
menstrual bleeding (HMB) in adolescents, few studies have compared the relative effectiveness
of hormone therapy on the basis of dose.
Design
Retrospective chart review
Setting
Urban tertiary care institution
Participants
Adolescents aged 9–19 years with acute HMB and anemia in 2008–2018
Interventions
We used billing codes to identify encounters for acute HMB with hemoglobin less than
12 mg/dl and reviewed initial treatment and time until resolution of acute HMB. We
excluded patients who had previously used gonadal steroids or did not complete follow-up.
We then compared patients who received combined oral ethinyl estradiol with progestin
(EE/P) in standard dosing (EE ≤35 mcg/day) vs taper dosing (EE >35mcg/day in any step-down
regimen).
Main Outcome Measures
Time until patient-reported resolution of acute HMB, measured in days from initial
treatment
Results
Of 207 patients with vaginal bleeding and anemia, 90 met the criteria for review of
therapy type and dose. Users of combined EE/P were hormone-naïve in 28/33 (84.8%)
of those who initiated standard EE/P and 22/32 (68.8%) who initiated taper dosing.
Bleeding duration was available for 15/28 (53.6%) and 18/22 (81.8%). Resolution of
HMB occurred in 0–9 days with standard dosing (mean ±SD 2.1 ± 2.3 days) versus 1–15
days for taper dosing (4.9 ± 4.7; p = 0.04). Excluding six outliers of zero or more than 10 days, HMB ceased by 2.6 and
3 days (n = 12 and 15; p = 0.62).
Conclusion
Currently recommended higher dose combined hormonal regimens do not appear to shorten
the time to resolution of acute HMB in adolescents.
Key Words
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References
- Menstrual physiology: implications for endometrial pathology and beyond.Hum Reprod Update. 2015; 21: 748-761
- Classification of menstrual bleeding disorders.Rev Endocr Metab Disord. 2012; 13: 225-234
- Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women.Obstet Gynecol. 2013; 121: 891-896
- Immunocytochemical localization of estrogen receptors in the macaque endometrium during the luteal-follicular transition.Endocrinology. 1986; 119: 2467-2475
- Immunocytochemical localization of estrogen receptors in the macaque reproductive tract with monoclonal antiestrophilins.Endocrinology. 1984; 114: 2002-2014
- Progesterone withdrawal up-regulates vascular endothelial growth factor receptor type 2 in the superficial zone stroma of the human and macaque endometrium: potential relevance to menstruation.J Clin Endocrinol Metab. 2000; 85: 3442-3452
- Reepithelialization of the uterine surface arises from endometrial glands: evidence from a functional mouse model of breakdown and repair.Endocrinology. 2010; 151: 3386-3395
- Steroid regulation of menstrual bleeding and endometrial repair.Rev Endocr Metab Disord. 2012; 13: 253-263
- Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding.Obstet Gynecol. 2019; 134: e71-e83
- Heavy menstrual bleeding in adolescents.J Pediatr Adolesc Gynecol. 2017; 30: 335-340
- Treatment of acute abnormal uterine bleeding in adolescents: what are providers doing in various specialties?.J Pediatr Adolesc Gynecol. 2016; 29: 286-291
- Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial.Obstet Gynecol. 2006; 108: 924-929
- Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding–a double-blind randomized control study.Obstet Gynecol. 1982; 59: 285-291
- High-dose medroxyprogesterone acetate for the treatment of dysfunctional uterine bleeding in 24 adolescents.Aust N Z J Obstet Gynaecol. 1997; 37: 228-231
- Bleeding disorders in adolescents.Obstet Gynecol Clin North Am. 2009; 36: 153-162
- Bleeding disorders in adolescents with heavy menstrual bleeding in a multicenter prospective US cohort.Haematologica. 2020; 105: 1969-1976
- They don't really take my bleeds seriously”: barriers to care for women with inherited bleeding disorders.J Thromb Haemost. 2021; 19: 1506-1514
- Patterns of von Willebrand disease screening in girls and adolescents with heavy menstrual bleeding.Obstet Gynecol. 2018; 131: 1121-1129
Article info
Publication history
Published online: October 19, 2021
Accepted:
October 4,
2021
Received in revised form:
September 13,
2021
Received:
July 1,
2021
Footnotes
Conflict of Interest Statement: Dr. Maureen K. Baldwin is an NIH Scholar (K12HD085809) and receives honoraria as a consultant for Bayer and Exeltis pharmaceutical companies. Dr. Kristina M. Haley receives grant funding from Hemostasis and Thrombosis Research Society and the American Thrombosis and Hemostasis Network. Both Dr. Baldwin and Dr. Haley serve in a Working Group for research priorities for the National Hemophilia Foundation and as medical advisory board members for the Foundation for Women and Girls with Bleeding Disorders. This current work was conducted without funding as an Ob/Gyn Resident Research project by the primary author, Lauryn Roth.
Funding: None
Prior Presentations: Oral presentation at OHSU Dept of Ob/Gyn Resident Research Day, Portland, OR, May 2020.
Identification
Copyright
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
