Irregular menses is not unusual in adolescents, especially while the hypothalamic–pituitary–adrenal axis is becoming established. However, heavy menstrual bleeding, especially in tandem with anovulation can lead to significant morbidity and may reflect an underlying bleeding disorder which requires further work-up. Heavy menstrual bleeding is defined as
Excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. It can occur alone or in combination with other symptoms
Menorrhagia is the most common finding in women of reproductive age. For adolescents, heavy bleeding can be very disruptive to quality of life, including participation in academics and extra-curricular activities. Heavy bleeding often starts at the onset of menses, but may not become overt until cycles become ovulatory. If an ObGyn or women’s healthcare provider is suspicious of an underlying bleeding disorder, specialty labs are required and coordinated care with an hematologist is recommended.
Additional VWD considerations
Other Bleeding Disorders to Consider
ACOG Committee Opinion 785: Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding
National Hemophilia Foundation: Philipp Screening Tool
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