Grand Rounds

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

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)

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

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

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