Heavy menstrual bleeding in adolescents: what is the best treatment?

Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Up to half of adolescents who present with heavy menstrual bleeding have a bleeding disorder, and this study suggests that a levonorgestrel intrauterine device (LGN-IUD) may be a better treatment option than combined oral contraceptives (OCs).
  • Authors acknowledge that adolescents may balk at LGN-IUD implantation, and combined OCs are a common choice.

Why this matters

  • Adolescents often experience heavy menstrual bleeding, which affects up to 37% and can be associated with iron deficiency anemia.
  • Some causes include hypothalamic-pituitary-gonadal axis immaturity.

Key results

  • 46% with heavy bleeding had a bleeding disorder. 
  • Most common bleeding disorder was von Willebrand disease.
  • Hb values did not differ between adolescents with heavy bleeding with and without bleeding disorders (P=.24).
  • However, iron deficiency anemia was higher without a bleeding disorder (P=.04).
  • LNG-IUD was the most effective solo hormonal therapy in 89%; patients using tranexamic acid plus hormonal therapy had 100% suppression.

Study design

  • Retrospective, 76 adolescents, mean age 14.4 years (range, 10-18 years); mean menarche age, 11.6 years.
  • 73 tested for a bleeding disorder.
  • Funding: None.

Limitations

  • Possibly inflated bleeding disorder prevalence because of specialty setting, which also may have underrepresented those who responded to combined OCs.