The adolescent with menorrhagia: Diagnostic approach to a suspected bleeding disorder

On the basis of epidemiologic studies and expert opinion, the adolescent female presenting with menorrhagia should be evaluated for a bleeding disorder. (8)(13) • On the basis of expert opinion and consensus guidelines, menorrhagia is defined as menstrual bleeding lasting for more than 7 days, sanitary product use greater than 7 per day, and a greater than 80-mL blood loss per menstrual cycle. (1) • On the basis of observational studies and expert opinion, a history of flooding and/or impairment of daily activities with periods, soaking through night clothes, passing clots greater than 1 inch in diameter, and iron deficiency anemia often identify patients with menorrhagia. (14) • On the basis of observational studies, the pictorial bleeding assessment calendar and the bleeding assessment questionnaire can be used to objectively quantify menstrual losses. (15)(42) • A thorough diagnostic evaluation includes studies for von Willebrand disease, platelet function defects, hemophilia A and B, and rarer clotting factor deficiencies. On the basis of observational studies, it is now appreciated that female carriers of factor deficiency often have symptomatic menorrhagia, even when factor levels are normal. (29) African American females investigated for menorrhagia more often have platelet function disorders than do white females. (23) • On the basis of observational studies and expert opinion, hormonal and hematologic treatment options are effective in controlling HMB in adolescents. (22)(24)(12)(33)(32)(40)(39) A combination of treatment modalities is often required to control menorrhagia. • On the basis of expert opinion, comprehensive management is best achieved when it involves a hematologist/oncologist, an obstetrician/gynecologist, and a primary care physician.