Menstrual Health in Children, Adolescents, and Young Adults with Cardiac Disease: An Underrecognized Component of Heart Failure, Mechanical Circulatory Support, and Transplant Care.

BACKGROUND

Menstrual abnormalities, including heavy menstrual bleeding, amenorrhea, and dysmenorrhea, are frequently encountered among children, adolescents, and young adults with congenital and acquired heart disease, yet remain underrecognized in routine cardiovascular care. Anticoagulation, thrombosis risk, heart failure physiology, and limited high-quality evidence complicate management and contribute to substantial variation in practice.

METHODS

The Advanced Cardiac Therapies Improving Outcomes Network convened a multidisciplinary working group of cardiologists, hematologists, gynecologists, adolescent medicine specialists, and allied health providers. Following a literature search, the group met monthly via virtual meetings to synthesize current evidence and clinical experience and develop consensus guidance.

RESULTS

The consensus emphasizes routine, developmentally appropriate menstrual screening and recognition that traditional definitions of heavy menstrual bleeding may underestimate its clinical impact in patients with heart disease. Management requires individualized assessment of bleeding risk, thrombotic risk, cardiac physiology, and patient preferences. Menstrual abnormalities may warrant broader evaluation for changes in overall health, cardiac status, or energy availability.

CONCLUSIONS

Menstrual health is integral to comprehensive cardiovascular care. Integrating screening and individualized management into cardiology practice may reduce morbidity, improve quality of life, and support equitable, sex-informed care. Further research and culturally responsive, multidisciplinary implementation are needed to strengthen the evidence base and improve care consistency.