Anovulatory bleeding and the spectrum of bleeding disorders: Understanding heavy menstrual bleeding in adolescents

Özer E., Akman A. Ö., Kurtipek F. B., Büyükyılmaz G., Bitkay A., Toksoy Adıgüzel K., ...More

International Journal of Gynecology and Obstetrics, 2025 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2025
  • Doi Number: 10.1002/ijgo.70579
  • Journal Name: International Journal of Gynecology and Obstetrics
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, Gender Studies Database, Public Affairs Index
  • Keywords: abnormal uterine bleeding, adolescent, bleeding disorder, heavy menstrual bleeding, platelet function defects, thrombocytopenia, von Willebrand disease
  • Ankara Yıldırım Beyazıt University Affiliated: Yes

Abstract

Objective: To investigate the frequency, etiology, and clinical characteristics of bleeding disorders (BD) in adolescents with heavy menstrual bleeding (HMB) and evaluate treatment outcomes. Methods: This retrospective study analyzed 515 adolescents (10–19 years) presenting with abnormal uterine bleeding (AUB) at a multidisciplinary clinic. After excluding 24 with chronic diseases, 491 patients were categorized as: anovulatory HMB (HMB-An, n = 305), BD (n = 40), and non-HMB anovulatory cycles (n = 146). All HMB patients underwent hemostatic and endocrine assessments, with coagulation and platelet function tests when indicated. Results: Among 345 HMB patients, 40 (11.6%) had BD. The most common cause was von Willebrand disease (vWD) (12/40, 30%), followed by coagulation factor deficiencies (11/40, 27.5%), thrombocytopenia (8/40, 20%), and platelet function defects (6/40, 15%). Hospitalization rates were higher in BD than HMB-An (25% vs 16%). Combined oral contraceptives (0.03 mg ethinyl estradiol + 0.15 mg levonorgestrel, tapered over 7–10 days) controlled bleeding in 85% of acute-phase HMB within a median of 3 days. VWD patients had a milder course, with fewer rates of HMB at menarche, prolonged bleeding, and transfusion needs. Conclusion: Bleeding disorders should be considered in all adolescents with HMB, particularly when hemoglobin is ≤10 g/dL. Persistent bleeding despite treatment requires re-evaluation, even if initial results are normal, with special attention to platelet dysfunction. Early recognition and prompt initiation of hormonal therapy, especially combined oral contraceptives, effectively reduce hospitalizations, transfusions, and improve quality of life.