Heavy or healthy? Assessing menstrual bleeding and bleeding tendency in Dutch adolescents

Heavy menstrual bleeding (HMB) is common in adolescents and may indicate a bleeding disorder. The pictorial blood loss assessment chart (PBAC) defines HMB as a score ≥150, while an elevated self-bleeding assessment tool (self-BAT) score identifies people at risk for a bleeding disorder (age 12-17 years ≥3 and 18-21 years ≥6). PBAC and self-BAT scores from the general menstruating population are, however, unknown.

To assess the prevalence and association of HMB and elevated self-BAT scores in adolescents.

Adolescents (aged 12-21 years) using the Menstruation Education Calendar application were included if they had completed the self-BAT and ≥1 PBAC. The Menstruation Education Calendar application is a mobile Health intervention and facilitates monitoring of menstrual blood loss. Logistic regression was used to assess the association between PBAC ≥150 and elevated self-BAT scores.

Between 2023 and 2024, 330 adolescents completed the workup. Of the participants, 22.1% (n=73/330) had a PBAC score ≥150, and 16.4% (n = 54/330) had an elevated self-BAT score. PBAC scores ≥150 were associated with an increased risk for an elevated self-BAT (odds ratio [OR], 2.48; 95% CI, 1.32-4.64). PBAC score ≥150 was equally prevalent in adolescents aged between 12 and 17 and 18 and 21 years (OR 0.70; 95% CI, 0.37-1.31). Adolescents aged 18 to 21 years had a lower risk for an elevated self-BAT compared with those aged 12 to 17 years (OR, 0.11; 95% CI, 0.06-0.20).

Of adolescents, 20% have HMB. In adolescents aged 12 to 17 years, the self-BAT cutoff score ≥3 is too sensitive, identifying ∼50% at risk for a bleeding disorder and strengthening the need for reassessing the self-BAT cutoff score in menstruating adolescents.