Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding

Approach to Abnormal Uterine Bleeding in Adolescents

“…Initial evaluation of adolescents presenting with acute AUB should include screening for pregnancy, anemia, bleeding disorders, iron deficiency and thyroid disease (15). Complete blood count, blood type, cross match and pregnancy test should be first line tests.…”

<p>Potential Undiagnosed VWD Or Other Mucocutaneous Bleeding Disorder Cases Estimated From Private Medical Insurance Claims</p>

“…17 Improvements in the recognition and diagnosis of VWD in adolescent girls are also needed. 28 Despite evidence that VWD is among the most commonly encountered bleeding disorders in adolescents with abnormal uterine bleeding 29 and that testing may be cost-effective, 30 laboratory testing is performed infrequently 31,32 and diagnosis may be delayed into adulthood. 33 In 2001, the American College of Obstetricians and Gynecologists (ACOG) indicated that routine screening for coagulation disorders in adolescents with anovulatory bleeding was warranted, and that an underlying coagulopathy such as VWD should be considered in all patients (particularly adolescents) with abnormal uterine bleeding.…”

Utility of a screening tool for haemostatic defects in a multicentre cohort of adolescents with heavy menstrual bleeding

“…Heavy menstrual bleeding (HMB) is often multifactorial . Of the possible causes, anovulation is likely to be the most common reason for HMB in this age group, but other aetiologies, such as underlying haemostatic disorders (HDs), are often present . A growing body of literature suggests that 10%‐62% of adolescents with HMB may have an underlying HD …”

“…age group, 5 but other aetiologies, such as underlying haemostatic disorders (HDs), are often present. 6 A growing body of literature suggests that 10%-62% of adolescents with HMB may have an underlying HD. [7][8][9][10] The reporting and interpretation of HMB is subjective.…”

“…Wide ranges of reported prevalence, difficulty in discerning normal from excessive bleeding, widespread use of hormones and the mundane nature of the "heavy period" complaint make identification of HDs in adolescents challenging. 6 Bleeding assessment tools (BATs) can accurately distinguish normal from abnormal bleeding, identify patients with mild bleeding disorders and can be used to describe bleeding severity. Most validated BATs quantify overall bleeding symptoms, including complaints of HMB.…”