title: Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.
abstract: OBJECTIVE
  To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders.
  
  
  METHODS
  We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area.
  
  
  METHODS
  Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders.
  
  
  RESULTS
  Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment.
  
  
  CONCLUSIONS
  Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. Electronic address: dowlutmcelroyt@umkc.edu.
authors.forename: Tazim
authors.initials: T
authors.lastname: Dowlut-McElroy
authors.affiliation: Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Williams
authors.affiliation: Section of Hematology, Division of Hematology/Oncology/Bone Marrow Transplant, Children's Mercy Hospitals, Kansas City, Missouri.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Carpenter
authors.affiliation: Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Section of Gynecological Surgery, Department of Surgery, Children's Mercy Hospitals, Kansas City, Missouri.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Strickland
mesh_terms: D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000150:complications*; D002648:Child; D005260:Female; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D008572:Menarche; D008595:Menorrhagia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008598:Menstruation / Q000502:physiology*; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult; D014842:von Willebrand Diseases / Q000150:complications / Q000503:physiopathology
chemical_list: D006728:Hormones
keywords: Adolescent; Bleeding disorder; Heavy menstrual bleeding; Menstrual patterns