The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2026
Comparative Efficacy of Medical Therapies for Heavy Menstrual Bleeding in Adolescents and Young Adults With Bleeding Disorders.
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Huang He, Isaacson Erin, Weyand Angela C, McCracken Kate, Rosen Monica W, Dendrinos Melina L
Аннотация
PURPOSE: Adolescent and young adult (AYA) females with bleeding disorders (BDs) frequently experience heavy menstrual bleeding (HMB), posing substantial clinical challenges. Data comparing the efficacy of specific hormonal treatment options in this population remain limited.
METHODS: We conducted a retrospective review of AYA females (≤21 years) with BD and HMB referred to a multidisciplinary Pediatric and Adolescent Gynecology-Pediatric Hematology joint clinic between November 2016 and December 2023. Treatment efficacy was defined as achieving a patient-reported significant reduction in or cessation of menstrual bleeding. The primary objective was to compare the efficacy of different hormonal and hemostatic therapies.
RESULTS: Among 121 AYA females with BD, von Willebrand disease was the most common diagnosis (67.0%). HMB developed within 1 year of menarche in 79.3% of cases, and 73.6% received their BD diagnosis only after HMB onset. Combined estrogen-progestin oral contraceptive pills (OCPs) were the most common initial therapy (62.8%), yet 58.7% required switching to alternative regimens. Oral progestins demonstrated the highest efficacy (89.8%), followed by levonorgestrel-releasing intrauterine system (81.5%) and OCPs (65.5%). Only 17.4% achieved complete amenorrhea, though most experienced clinically meaningful bleeding reduction. Treatment efficacy differed significantly across modalities (p < .001).
DISCUSSION: Progestin-based therapies, particularly norethindrone and norethindrone acetate, offer superior bleeding control and should be considered first-line treatment in AYA with BD. Levonorgestrel-releasing intrauterine system and OCPs are also effective alternatives. Given the difficulty of achieving complete amenorrhea, clinical goals should prioritize meaningful bleeding reduction that supports quality of life. Early multidisciplinary referral is recommended to optimize individualized care.
METHODS: We conducted a retrospective review of AYA females (≤21 years) with BD and HMB referred to a multidisciplinary Pediatric and Adolescent Gynecology-Pediatric Hematology joint clinic between November 2016 and December 2023. Treatment efficacy was defined as achieving a patient-reported significant reduction in or cessation of menstrual bleeding. The primary objective was to compare the efficacy of different hormonal and hemostatic therapies.
RESULTS: Among 121 AYA females with BD, von Willebrand disease was the most common diagnosis (67.0%). HMB developed within 1 year of menarche in 79.3% of cases, and 73.6% received their BD diagnosis only after HMB onset. Combined estrogen-progestin oral contraceptive pills (OCPs) were the most common initial therapy (62.8%), yet 58.7% required switching to alternative regimens. Oral progestins demonstrated the highest efficacy (89.8%), followed by levonorgestrel-releasing intrauterine system (81.5%) and OCPs (65.5%). Only 17.4% achieved complete amenorrhea, though most experienced clinically meaningful bleeding reduction. Treatment efficacy differed significantly across modalities (p < .001).
DISCUSSION: Progestin-based therapies, particularly norethindrone and norethindrone acetate, offer superior bleeding control and should be considered first-line treatment in AYA with BD. Levonorgestrel-releasing intrauterine system and OCPs are also effective alternatives. Given the difficulty of achieving complete amenorrhea, clinical goals should prioritize meaningful bleeding reduction that supports quality of life. Early multidisciplinary referral is recommended to optimize individualized care.