Heavy menstrual bleeding in adolescents: hormonal or hematologic?

Area of Science:

• Adolescent Gynecology
• Hematology
• Endocrinology

Background:

• Heavy menstrual bleeding (HMB) is a frequent medical issue during female adolescence.
• HMB is often underreported due to subjective definitions of "normal" menstrual flow.
• Immature hypothalamic-pituitary-ovarian axis can cause anovulatory cycles, but other causes must be excluded.

Purpose of the Study:

• To review the common causes of heavy menstrual bleeding in adolescent girls.
• To discuss diagnostic considerations and differential diagnoses for HMB.
• To outline current management strategies and the importance of a multidisciplinary approach.

Main Methods:

• Literature review of causes, diagnosis, and management of HMB in adolescents.
• Analysis of differential diagnoses including bleeding disorders and endocrinopathies.
• Synthesis of treatment options and care coordination strategies.

Main Results:

• Common causes include immature HPO axis, von Willebrand disease, platelet disorders, and endocrinopathies (e.g., PCOS, hypothyroidism).
• Other considerations include anatomical anomalies, pregnancy, obesity, and medications.
• Management depends on clinical presentation and may involve hormonal therapy, antifibrinolytics, or intrauterine devices.

Conclusions:

• Accurate diagnosis of HMB in adolescents requires excluding underlying bleeding disorders and medical conditions.
• Effective management necessitates a comprehensive, multidisciplinary team approach involving various specialists.
• Timely and appropriate intervention can lead to better outcomes for adolescent girls experiencing HMB.