Management of Heavy Menstrual Bleeding in Adolescents

Initial Assessment and Diagnostic Workup

• The International Society on Thrombosis and Haemostasis recommends obtaining a detailed bleeding history using a validated bleeding assessment tool, such as the ISTH BAT score, to identify patients requiring hematologic investigation, with normal reference ranges being <3 in children 1
• Assessing for family history of bleeding disorders is crucial, as 98% of clinicians include this in initial bleeding assessment, and a positive family history significantly increases the likelihood of an inherited bleeding disorder 1

Management Based on Underlying Diagnosis

• For patients with Factor X deficiency, therapeutic options include antifibrinolytics, hormonal contraceptives, and clotting factor replacement, according to the American Society of Hematology 2

Critical Pitfalls to Avoid

• The American College of Obstetricians and Gynecologists advises against performing hysterectomy in adolescents, as it carries a high major adverse event rate, elevated cardiovascular disease risk, mood disorders, and increased mortality 6
• Ensure hemoglobin monitoring, as levels below 7 g/dL represent severe anemia requiring urgent intervention, including blood transfusion, as recommended by the American Academy of Pediatrics 6