Management of Heavy Menses in Adolescent Women. Janice L. Bacon, M.D. DISCLOSURE. I have no financial relationships with any commercial interests related to the content of this activity today. Objectives. Discuss: Common causes of Menorrhagia in adolescent women
Janice L. Bacon, M.D.
I have no financial relationships with any commercial interests related to the content of this activity today.
Menstruation in Girls and Adolescents. ACOG committee opinion, Nov. 2006.
[Take care to Provide teens some comfort and modesty!]
**Hgb/Hct is the most important discriminating test!
**Assess hemodynamic stability when acute bleeding present.
Most common etiology = anovulation
Order laboratory tests based on medical history
Immediate: Menstrual Regulation (3-6 mos)
Micronized P 400 mg qhs x 10 days
Medroxyprogesterone acetate 20 mg/d x 10 days
Cyclic hormonal contraception
Progestin – only ocp’s
E + P Ocp’s
Consider other medical needs:
Uncontrolled bleeding or recurrent episodes many prompt future evaluation
Evaluation for Bleeding Disorders:
CBC with differential
Platelet function screen (collagen ADP)
Von Willibrands factor antigen
Ristocetin cofactor activity
Factor VIIl activity
(Blood type 0=i VWf levels)
Evaluation for endocrinopathy:
Evaluation of pelvic anatomy:
Asses endometrial stripe/exclude ovarian cystsMedical Evaluation:
Noncyclic hormonal therapy
(May combine routes of administration )
(diabetes / liver dz / renal failure)
- Exclude bleeding disorders
complete metabolic profile
pertinent endocrine studies
Dr. Vore, et al. Obstet Gynecol (1982) 59; 285.
Endometrial ablation, uterine artery embolization or hysterectomy are not appropriate for adolescent women
Fraser, et a. Aust. NZ Obstet Gynaecol 1991; 311: 66-70
Ref: BJ Obstet Gynecol. June (1998) 105; p. 592
AMJ Obstet Gynecol (2005) 193: 1361
BJ of Obstet Gynaecol (1990) 97: 690
Contraception (2009) 79: 418