Diagnostic Evaluation and Therapeutic Approach to Management of Acute Heavy Menstrual Bleeding in Adolescents Utilizing a Clinical Practice Pathway and Comparison of Response by BMI: A 5-Year Retrospective Cohort Study in a Children' Hospital.

Abstract

Objective: To compare differences by body mass index (BMI) in (1) menstrual characteristics, (2) laboratory evaluation, and (3) hospitalization outcomes among adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department (ED) using a standardized clinical pathway.

Methods: A retrospective chart review was conducted for menstruating patients aged 8-25 years with acute HMB ED encounters at a large tertiary children's hospital network from 2017-2022. Patients were grouped by BMI (<85^th vs ≥85^th percentile). Demographics, menstrual characteristics, and laboratory studies were compared between BMI groups using two-sample hypothesis tests. Among hospitalized patients, the effect of BMI on treatment outcomes of length of stay (LOS), red blood cell (RBC) transfusion, and ongoing HMB requiring secondary medication (tranexamic acid (TXA) utilization) was assessed using logistic regression. Multivariable models were adjusted for medication and laboratory values.

Results: Among the 515 patients with documented BMI, 367 were hospitalized, and received medication (35% norethindrone acetate, 65% IV conjugated estrogen). Patients with elevated BMI more often experienced menarche before age 12 (58% vs 47%, p=0.011). Most demographics and labs did not differ by BMI. Endocrine labs were more frequently drawn for elevated BMI, per clinical pathway recommendations. No significant differences in treatment outcomes were observed by BMI. Multivariable analysis showed no association between BMI ≥ 85^th percentile and prolonged LOS, RBC transfusion, or TXA use.

Conclusion: While menstrual characteristics and laboratory evaluation varied slightly by BMI, management and treatment outcomes did not.