Prevalence of Heavy Menstrual Bleeding in Adolescents with Mullerian Anomalies: A 10-Year Single-Center Retrospective Cohort Study.

Background: Heavy menstrual bleeding (HMB) is a common complaint in young women in the general population and is associated with disruptions in physical, mental, and social well-being. This study aimed to describe the prevalence of HMB among adolescents with Mullerian anomalies.

Methods: We conducted a retrospective cohort study of adolescents diagnosed with a Mullerian anomaly at a tertiary children's health system from 2014-2024. We queried the Electronic Health Record (EHR) for the following diagnostic codes: Mullerian anomaly, uterine anomaly, bicornuate uterus, didelphic uterus, uterine septum, unicornuate uterus, and arcuate uterus. We defined HMB as provider diagnosis of HMB, menorrhagia, or prolonged menstrual bleeding. We collected data on patient race, age of menarche, age at time of diagnosis of Mullerian anomaly and HMB, subtype of Mullerian anomaly diagnosis, imaging modality used in diagnosis, presence or absence of a bleeding disorder evaluation, and treatment received for HMB. Only adolescents with a confirmed Mullerian anomaly and a documented menstrual history who had reached menarche were included in the analysis.

Results: Of the 140 adolescents included, 60 (43%) experienced HMB. HMB was most prevalent in those with bicornuate uterus (58%), uterine septum (55%), and arcuate uterus (50%). The most common treatment for HMB was combined hormonal contraception (44%).

Conclusion: The prevalence of HMB in adolescents with Mullerian anomalies in this cohort was 43% but varied by subtype. Understanding the prevalence of HMB in patients with specific Mullerian anomalies will allow clinicians to provide improved anticipatory guidance for this patient population.