Clinical Indicators and Treatment Preferences in Adolescents with Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) poses a serious health issue causing impairment of quality of life and necessitate urgent medical attention. This study aimed to detect the clinical indicators for common causes of HMB in adolescents and to assess the factors that influence clinicians' treatment choices.

The researchersanalyzedelectronic medical records of adolescents aged 10 to 18 with HMB from 2010 to 2022, resulting in a sample of 205 individuals. Clinical, laboratory, and treatment information was reviewed retrospectively.

The results indicated:

• A total of 63.9% of patients were diagnosed with hypothalamic-pituitary-ovarian (HPO) axis immaturity, 13.7% with bleeding disorders (BD), and 12.2% with polycystic ovary syndrome (PCOS). 
• No significant differences were noted in the severity of bleeding or duration of bleeding at presentation among the groups.
• However, patients with BD had lower hemoglobin (Hb) levels and were more likely to require hospitalization.
• Among all participants, 34.6% received only iron supplements, 44.9% were treated with low-dose hormones, and 15.6% with high-dose hormones. 
• Factors that led to the use of high-dose hormone therapy included lower Hb levels, treatment location (emergency room vs. clinic), and a history of multiple ER visits.

To summarize, although physicians tend to initiate high-dose hormonal treatments based on objective factors like Hb levels and hospitalization needs, clearer guidelines are required for starting low-dose hormonal therapies. Hence, there is a need for standardized protocols and practical implementation strategies for managing HMB in adolescents.

Source:Goker ETA, Kizilkan MP, Ersan FG, Akgul S, Aksu T, Aytac S, Derman O, Teksam O. Heavy menstrual bleeding in adolescents: Evaluation of diagnostic indicators and treatment preferences. Int J Gynaecol Obstet. 2024 Dec 31. doi: 10.1002/ijgo.16132. Epub ahead of print. PMID: 39739559.