Management of Abnormal Bleeding in the Adolescent

Heavy menstrual bleeding is the most common sign of an acquired or inherited bleeding disorder in females. For many young women, the manifestations of an inherited bleeding disorder do not surface until menarche, which can lead to a delay in diagnosis. Besides heavy menstrual bleeding, patients can have menstrual pain from bleeding into the corpus luteum, bleeding from trauma or procedures, easy bruising, and gastrointestinal bleeding. An undiagnosed bleeding disorder can lead to severe blood loss, chronic iron deficiency, and unnecessary surgical procedures, such as a hysterectomy. Therefore, identifying a possible bleeding disorder in these young women is crucial to allow an initiation of targeted therapy. Management of bleeding will depend on the diagnosis, as well as the severity and bleeding location. Many adolescent females with menorrhagia can be successfully managed with a combination of hormonal control and/or antifibrinolytics. Depending on the diagnosis, treatment can also include coagulation factor replacement, blood product transfusion, as well as specific therapies for acquired bleeding disorders, such as intravenous immune globulin, plasmapheresis, or corticosteroids.