Bleeding disorders and heavy menses in adolescents

The aim of this article is to review the current evidence for optimal management of the adolescent who presents with heavy periods.

A recent survey of clinicians involved in adolescent gynaecology revealed a lack of consistency in the management of acute adolescent heavy menses. Very few randomized trials have been undertaken for acute heavy menses in women of any age, although one recent trial compared the oral contraceptive pill with oral medroxy progesterone acetate in adult women and showed them to be equally effective. The applicability of this trial to adolescents is unclear. Furthermore, although guidelines have been produced for menorrhagia management in adults, there is again only limited clinical research specific to adolescents and thus room for concern that the approaches for adult women may not always be appropriate for teenagers. One small study on the successful use of the levonorgestrel intrauterine system in teenagers does mean that this management option can now be considered.

There is a need for careful assessment of the menstrual problem for, although anovulatory bleeds are the most common cause, bleeding disorders also need to be considered. Pelvic pathology is uncommon. Adolescents can also present with acute ongoing heavy bleeding. Whilst a range of approaches is reported, there are no studies to guide optimal management.