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- Rudi-Ann Graham, MD*,†
- Joanna A. Davis, MD†,‡
- Fernando F. Corrales-Medina, MD*,†,‡
- *Department of Pediatrics, Holtz Children’s Hospital–Jackson Memorial Medical Center, Miami, FL
- †Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami–Miller School of Medicine, Miami, FL
- ‡University of Miami–Hemophilia Treatment Center, Miami, FL
AUTHOR DISCLOSURE
Dr Graham has disclosed no financial relationships relevant to this article. Dr Davis has disclosed that she is a medical advisory board member for Bayer Pharmaceuticals, Genentech, CSL Behring, Novo Nordisk, Bioverativ, and Octapharma and a phase III trial study coordinator for CSL Behring and Bayer Pharmaceuticals. Dr Corrales-Medina has disclosed that he has grant awards from Bayer and Shire and is an advisory board member for Bayer, Genentech, Octapharma, and Shire. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- ACOG:
- American Academy of Obstetrics and Gynecology
- COCP:
- combined oral contraceptive pill
- DDAVP:
- 1-deamino-8-D-arginine vasopressin
- FVIII:
- factor VIII
- FIX:
- factor IX
- GnRH:
- gonadotropin-releasing hormone
- HMB:
- heavy menstrual bleeding
- LNG-IUS:
- levonorgestrel-releasing intrauterine system
- LTA:
- light transmission aggregometry
- PBAC:
- pictorial bleeding assessment calendar
- PFD:
- platelet function defect
- TA:
- tranexamic acid
- vWD:
- von Willebrand disease
- vWF:
- von Willebrand factor
Practice Gaps
To deliver comprehensive care to the adolescent with menorrhagia, clinicians should recognize patterns of menstrual loss that are atypical of that associated with physiologic hormonal changes. There remains a need for consideration of possible underlying bleeding diatheses when screening the adolescent with heavy menstrual bleeding.
Clinicians should be aware of the treatment modalities available to the adolescent with menorrhagia and an underlying bleeding disorder and understand when referral to a hematologist is indicated.
Objectives
After completing this article, readers should be able to:
Define menorrhagia.
Use validated screening tools to identify menorrhagia.
Identify cases of menorrhagia in the adolescent that warrant further hematologic evaluation based on predictors noted on history and physical examination.
Review the most common bleeding disorders associated with menorrhagia in the adolescent and the diagnostic approach to each disorder.
Identify the hormonal and hematologic treatment modalities available for use in the adolescent with menorrhagia and understand the limitations of using each treatment in this age group.
Recognize when a referral to a pediatric hematologist/oncologist is indicated.
Overview
Adolescent girls and young women often seek medical attention because of menorrhagia, or heavy menstrual bleeding (HMB). Menorrhagia is defined as menstrual bleeding lasting for more than 7 days, sanitary product use greater than 7 per day, and greater than 80 mL of …
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