Heavy menstrual bleeding in adolescents: Evaluation of diagnostic indicators and treatment preferences

Heavy menstrual bleeding (HMB) is a significant health concern that may lead to critical medical care and impaired quality of life. The aim of the present study was to identify the clinical indicators of common causes of HMB in adolescents and evaluate the factors influencing the treatment preferences of clinicians.

Between 2010 and 2022, the electronic medical records of adolescents between the ages of 10-18 with HMB were reviewed, and a final of 205 adolescents was included. Clinical, laboratory, and treatment data were retrospectively analyzed.

Hypothalamic-pituitary-ovarian (HPO) axis immaturity was diagnosed in 63.9%, bleeding disorders (BD) in 13.7%, and polycystic ovary syndrome (PCOS) in 12.2% of the patients. The presence of "heavy bleeding" and the bleeding length at presentation were not different between the groups. Patients with a BD presented with lower hemoglobin (Hb) levels (P = 0.019), and more frequently required inpatient admissions (P = 0.005). Of all patients, 34.6% were given only iron, 44.9% were given a low dose, and 15.6% were given a high-dose hormone treatment. Factors influencing high-dose hormone regimens were lower Hb levels (P < 0.001), the place of visit (ER rather than the clinic) (P < 0.001), and the presence of multiple ER visits (P < 0.001).

Physicians base their decisions to start high-dose hormonal therapy on objective parameters such as Hb levels and the need for hospitalization, while more precise guidelines are deemed necessary for initiating low-dose hormonal therapy. Standardized protocols and their practical implementation at the clinical level are needed for the management of HMB in adolescence.