title: Menorrhagia in adolescents with inherited bleeding disorders.
abstract: OBJECTIVE
  We reviewed the management and treatment outcomes of menorrhagia in adolescents with inherited bleeding disorders and assessed the impact of menorrhagia on their quality of life.
  
  
  METHODS
  Retrospective review of case notes and a questionnaire study.
  
  
  METHODS
  Comprehensive-care hemophilia treatment center.
  
  
  METHODS
  Adolescents with inherited bleeding disorders who had registered at the center and were attending the multidisciplinary hemophilia and gynecology clinic for management of menorrhagia.
  
  
  METHODS
  Review of medical records and assessment of menstrual blood loss using the pictorial blood assessment chart and quality of life measurements during menstruation using a questionnaire.
  
  
  METHODS
  Scores on pictorial blood assessment charts and quality of life measurements before and after treatment.
  
  
  RESULTS
  Of 153 girls aged 12 to 19 years who had registered at the center and had an inherited bleeding disorder, 42 (27%) attended the multidisciplinary clinic for management of menorrhagia. The majority (38/42; 90%) had experienced menorrhagia since menarche. Of the group, 5 (12%) required hospital admission for acute menorrhagia and severe anemia. Treatment options for menorrhagia included tranexamic acid, desmopressin, combined oral contraceptive pills, clotting factor concentrate, and the levonorgestrel intrauterine system. These treatment modalities, alone or in combination, were associated with a reduction in menstrual blood loss (median pre- and posttreatment pictorial blood assessment chart scores were 215 and 88, respectively) and improvement in quality of life scores (median pre- and posttreatment were 26 and 44, respectively).
  
  
  CONCLUSIONS
  Menorrhagia is a common symptom in adolescents with inherited bleeding disorders. It can present acutely, and it adversely affects quality of life. Treatment options include hemostatic and/or hormonal therapies and can improve the quality of life of affected girls.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Chi
authors.forename: Debra
authors.initials: D
authors.lastname: Pollard
authors.forename: Edward G D
authors.initials: EG
authors.lastname: Tuddenham
authors.forename: Rezan A
authors.initials: RA
authors.lastname: Kadir
mesh_terms: D000293:Adolescent; D025861:Blood Coagulation Disorders, Inherited / Q000150:complications*; D001791:Blood Platelet Disorders / Q000150:complications*; D002648:Child; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy / Q000209:etiology*; D011788:Quality of Life; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D006490:Hemostatics