Anovulatory bleeding and the spectrum of bleeding disorders: Understanding heavy menstrual bleeding in adolescents.

OBJECTIVE

To investigate the frequency, etiology, and clinical characteristics of bleeding disorders (BD) in adolescents with heavy menstrual bleeding (HMB) and evaluate treatment outcomes.

METHODS

This retrospective study analyzed 515 adolescents (10-19 years) presenting with abnormal uterine bleeding (AUB) at a multidisciplinary clinic. After excluding 24 with chronic diseases, 491 patients were categorized as: anovulatory HMB (HMB-An, n = 305), BD (n = 40), and non-HMB anovulatory cycles (n = 146). All HMB patients underwent hemostatic and endocrine assessments, with coagulation and platelet function tests when indicated.

RESULTS

Among 345 HMB patients, 40 (11.6%) had BD. The most common cause was von Willebrand disease (vWD) (12/40, 30%), followed by coagulation factor deficiencies (11/40, 27.5%), thrombocytopenia (8/40, 20%), and platelet function defects (6/40, 15%). Hospitalization rates were higher in BD than HMB-An (25% vs 16%). Combined oral contraceptives (0.03 mg ethinyl estradiol + 0.15 mg levonorgestrel, tapered over 7-10 days) controlled bleeding in 85% of acute-phase HMB within a median of 3 days. VWD patients had a milder course, with fewer rates of HMB at menarche, prolonged bleeding, and transfusion needs.

CONCLUSION

Bleeding disorders should be considered in all adolescents with HMB, particularly when hemoglobin is ≤10 g/dL. Persistent bleeding despite treatment requires re-evaluation, even if initial results are normal, with special attention to platelet dysfunction. Early recognition and prompt initiation of hormonal therapy, especially combined oral contraceptives, effectively reduce hospitalizations, transfusions, and improve quality of life.