Abnormal vaginal bleeding in adolescence as the presenting symptom of a bleeding diathesis

Menorrhagia in adolescents may be the presenting sign of a systemic hemostatic disorder. The evaluation of adolescents with menorrhagia should include an assessment of the pelvic organs to exclude anatomic pathology, and if none is found the possibility of primary hematological abnormality should be considered. Initially, a thorough personal and family history of a bleeding tendency should be obtained. Thereafter, we suggest a number of basic "screening" clotting assays be performed. These should include a platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen level and bleeding time. Abnormalities of any of these tests should then be further investigated using more specific clotting assays. The most common disorders reported to cause menorrhagia in adolescents are von Willebrand's disease, factor XI deficiency, and Glanzmann's thrombasthenia. General and specific therapeutic measures for treating these disorders are discussed.