Evaluation of Heavy Menstrual Bleeding in Adolescents

Heavy menstrual bleeding (HMB) in adolescents often manifests as “excessive bleeding” and may result in acute anemia requiring emergency treatment. The aim of this study was to evaluate the diagnostic and management options for adolescents with HMB.

Retrospective data were collected from patients’ medical records. Adolescents were classified based on the degree of anemia: Group 1 included patients with hemoglobin (Hb) levels of <8 g/dL; Group 2, Hb levels of 8-10 g/dL; Group 3, Hb levels of 10-12 g/dL; and Group 4, Hb levels of ≥12 g/dL. Admission and follow-up characteristics were compared across groups.

The cohort consisted of 122 adolescents with a mean age of 13.7±1.9 years, 42.7% of whom experienced menstrual irregularity within two years of menarche. The median duration of bleeding was 16 (10-30) days. Anovulation was identified in 57.8% of patients. Polycystic ovary syndrome was diagnosed in 32 (25%) adolescents, hypothyroidism in 6 (4.7%), uterine structural anomalies in 3 (2.3%), and hyperprolactinemia in 3 (2.3%), 2 of whom had microprolactinoma. One adolescent was diagnosed with von Willebrand disease following a hematological evaluation.

Primary care providers should understand normal menstrual cycle patterns and thus be adept at identifying HMB. Early recognition of the underlying etiology in adolescents facilitates timely diagnosis, helping to prevent severe anemia and potential hospitalization.