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