Laboratory Workup for Heavy Menstrual Bleeding in Adolescents

Initial Essential Laboratory Tests

The American Society of Hematology recommends a complete blood count (CBC) to assess for anemia severity and rule out thrombocytopenia or thrombocytosis as potential causes of bleeding in adolescents with heavy menstrual bleeding 1, 2
A pregnancy test (β-hCG) should be performed to exclude pregnancy complications, including incomplete abortion or gestational trophoblastic disease, in adolescents with heavy menstrual bleeding 3
Prothrombin Time (PT) and Activated Partial Thromboplastin Time (PTT) should be screened for coagulation factor deficiencies in adolescents with heavy menstrual bleeding 1, 2

A validated bleeding assessment tool, such as the ISTH BAT score, should be used to systematically evaluate bleeding risk in adolescents with heavy menstrual bleeding, with normal reference ranges being <3 in children 4
Key bleeding history questions to assess in adolescents with heavy menstrual bleeding include personal history of excessive bleeding, family history of bleeding disorders, and presence of easy bruising or other mucocutaneous bleeding 1, 2, 4

Ecchymoses, hematomas, petechiae, or other evidence of recent bleeding should be documented in adolescents with heavy menstrual bleeding 1, 2
Signs of anemia, including pallor and tachycardia, should be documented in adolescents with heavy menstrual bleeding 1, 2

Prolactin levels should be checked if there are signs of hyperprolactinemia or galactorrhea in adolescents with heavy menstrual bleeding 5
Pelvic ultrasound (transvaginal preferred) should be performed to evaluate for structural abnormalities, including fibroids, polyps, adenomyosis, and endometrial thickness, in adolescents with heavy menstrual bleeding 3

The American College of Obstetricians and Gynecologists recommends combined oral contraceptives (30-35 μg ethinyl estradiol) as first-line medical management for menorrhagia in adolescents 3
Levonorgestrel IUD is highly effective but may be less appropriate for adolescents with heavy menstrual bleeding 3