Heavy Menstrual Bleeding Common in Teens, Requires Multidisciplinary Care

By Reuters Staff

January 02, 2020

NEW YORK (Reuters Health) - Heavy menstrual bleeding is a common problem in adolescent girls and requires a multidisciplinary approach to facilitate timely diagnosis and appropriate treatment, say the authors of a review of the topic in JAMA Pediatrics.

The reported prevalence of heavy menstrual bleeding (HMB) ranges from 34% to 37%, Dr. Claudia Borzutzky and Dr. Julie Jaffray from Keck School of Medicine, University of Southern California, Los Angeles, note in their paper.

HMB can lead to anemia, fatigue and hemodynamic instability, which may result in emergency department visits, hospital stays, the need for transfusion and oral or intravenous therapies to stop blood loss.

Ovulatory dysfunction is the most common cause of HMB in adolescents, followed by coagulopathies.

HMB is often associated with a congenital or acquired bleeding disorder; von Willebrand disease is the most common inherited bleeding disorder and its incidence is high in adolescent girls with HMB.

Drs. Borzutzky and Jaffray say it's important to distinguish the etiology of HMB in adolescent girls to guide treatment, which can include hemostatic medications, hormonal agents, or a combination of both.

Among hormonal agents, studies have shown that the 52-mg levonorgestrel intrauterine device is "highly superior to other hormonal methods in its effect on HMB" and is well tolerated in adolescents, including those with a bleeding disorder, they point out.

"Historically, the evaluation of HMB has been predominantly the role of a primary care clinician or gynecologist," the authors note. "Given that a high prevalence of female individuals (specifically adolescents) with HMB have underlying bleeding disorders, hematologists should also have a prominent role," they advise. "Likewise, given the complexity of diagnosing and managing these disorders, a multidisciplinary approach provides improved time to diagnosis and bleeding control as well as the most efficacious use of medical resources."

Drs. Borzutsky and Jaffray say the ideal multidisciplinary clinic includes a hematologist, pediatric and adolescent gynecologist or adolescent medicine specialist, nurse and psychologist or social worker.

"Given the excellent treatment options available for HMB and bleeding disorders, adolescents receiving such coordinated care have the potential to live normal, healthy, and developmentally appropriate lives with few limitations," they conclude.

SOURCE: http://bit.ly/2ME3tn2 JAMA Pediatrics, online December 30, 2019.