Bleeding disorders in adolescents with heavy menstrual bleeding: A 10 year experience of Queensland paediatric and adolescent gynaecology service

Abstract

Introduction Heavy menstrual bleeding (HMB) is a common gynaecological complaint among adolescents. In many cases, immaturity of the hypothalamic-pituitary-ovarian axis, leading to anovulatory cycles, is thought to be the underlying cause. However, it is prudent to consider the presence of an underlying bleeding disorder (BD). Methods We retrospectively reviewed the medical records of patients with HMB that presented to the Queensland Paediatric and Adolescent Gynaecology (PAG) Service from July 2007 to July 2017. Results 124 adolescents with HMB were identified and screening for a BD was performed in 77/124 (62.1%). 29/124 (23.4%) of all patients or 29/77 (41.6%) of those screened had a BD. VWD or low VW was the most common and found in 14/29 (48%). A Platelet function disorder (PFD) was detected in 5/29 (17.2%), thrombocytopenia in 3/29 (10.3%), and clotting factor deficiency in 1/29 (3.4%). An abnormal bleeding screening was found in 4/ 29 (13.8%), yet to be diagnosed, and 2/29 (6.9%) were lost to follow-up. Iron deficiency and/or anaemia was screened for in 107/124 (86.3%) and diagnosed in 53/107 (49.5%). Discussion It is important to identify bleeding disorders in the adolescent female population because the obstetric and gynaecologic morbidity goes beyond troublesome heavy periods. Iron deficiency anaemia, fatigue, less time spent on desired activities, and difficulty performing schoolwork are common complaints. Furthermore, they are at increased risk of surgical and obstetric haemorrhage. Institution of appropriate management of menses in adolescents with BD will be of considerable benefit in preventing morbidity. Effective management can be accomplished with either hormonal medications alone or in conjunction with anti-fibrinolytic agents such as tranexamic acid, in the majority of patients. Iron deficiency should be managed with oral iron supplementation in the first instance. Severe bleeding episodes may benefit from directed therapies, such as desmopressin or clotting factor concentrates, and these agents may be valuable in perioperative prophylaxis and treatment of surgical and obstetric haemorrhage. Conclusion A significant proportion of adolescent girls with HMB referred to a PAG clinic will have a BD and the prevalence in this study is consistent with the literature. A higher level of awareness of these conditions, especially VWD and PFD, is needed and close collaboration between gynaecologists and haematologists in a specialised tertiary centre should be established in the management of these patients. Accurate and early recognition of bleeding disorders in the adolescent is critical for the management of bleeding complications and optimisation of therapy for HMB.L6215698402018-04-11 <br />