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Is Heavy Menstrual Bleeding a Sign of a Bleeding Disorder in Adolescents?

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BACKGROUND AND PURPOSE:

  • Von Willebrand disease, a genetic disorder, results in a quantitative or qualitative deficiency of von Willebrand factor
  • Menorrhagia beginning at menarche is often the first presenting symptom but the underlying cause often goes unrecognized
  • ACOG recommends screening for bleeding disorders in adolescents with menorrhagia and ≥1 of the following
    • Menses longer than 7 days or bleeding through a pad or tampon in 2 hours
    • Anemia
    • Family history of a bleeding disorder
    • History of bleeding after a hemostatic challenge (e.g., tooth extraction or surgery)
  • O’Brien et al. (Journal of Pediatric & Adolescent Gynecology, 2018) examined the prevalence of bleeding disorders in adolescents with heavy menstrual bleeding (HMB)

METHODS:

  • Retrospective review
  • Adolescents f between 8-18 years with HMB
  • Primary outcome: Diagnosis of a bleeding disorder
  • Secondary outcomes
    • Iron deficiency | Anemia | Various treatment modalities

RESULTS:

  • 124 patients were included in the study
    • 77 were screened for a bleeding disorder
  • 27 were diagnosed with a bleeding disorder
    • 21.7% of overall population
    • 35% of screened population
  • Of the group of bleeding disorders
    • Von Willebrand Disease: 51.6%
    • Inherited platelet function disorder: 33.3%
    • Thrombocytopenia (inherited or acquired): 11.1%
    • Factor IX deficiency: 3.7%
  • Iron deficiency and/or anemia were diagnosed in
    • 49.5% of screened patients
    • 70.3% of those diagnosed with a bleeding disorder

CONCLUSION:

  • This data confirms the importance of screening adolescents with heavy menstrual bleeding for bleeding disorders

Learn More – Primary Sources:

Bleeding disorders in Adolescents with Heavy Menstrual Bleeding (HMB): The Queensland Statewide Paediatric and Adolescent Gynaecology Service

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Related ObG Topics:

Are We Meeting the ACOG Screening Guidelines for Von Willebrand Disease in Adolescents with Menorrhagia?
Managing Abnormal Uterine Bleeding with Ovulatory Dysfunction
IUD, Hysterectomy or Ablation for Menorrhagia?

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