Diagnosis and Management of Heavy Menstrual Bleeding in Adolescents

Abstract

According to the American College of Obstetricians and Gynecologists (ACOG), abnormal uterine bleeding is defined as menstrual flow outside of normal volume, duration, regularity, or frequency.1 One of the most common reasons for an adolescent to be seen by a gynecologist, outside of birth control or sexually transmitted infection, is excessive or heavy menstrual bleeding (HMB), previously known as menorrhagia. Girls with excessive uterine bleeding may incur significant morbidity. As a result, both ACOG and the American Academy of Pediatrics (AAP) strongly encourage medical providers to assess patterns of menstrual bleeding routinely in all adolescent girls. To identify possible pathologic processes and to improve quality of life, these organizations recommend that menses be documented as a vital sign.2,3 Knowledge of what would be considered normal menses is important for practitioners caring for this patient population. However, there is a gap between typical understanding and management of bleeding in adolescents and the recommendations of ACOG and the AAP. The goal of this lesson is to help practitioners better define, diagnose, and manage abnormal bleeding in this population.