051 Heavy menstrual bleeding in teenagers: Haematological issues

Abstract

Up to one in three adolescent girls who present to the gynecologist with heavy menstrual bleeding (HMB) may have an underlying bleeding disorder [ [1] Zia A. Jain S. Kouides P. Zhang S. Gao A. Salas N. et al. Bleeding disorders in adolescents with heavy menstrual bleeding in a multicenter prospective US cohort. Haematologica. 2020; 105: 1969-1976 Crossref PubMed Scopus (18) Google Scholar ]. Unfortunately, this often remains unrecognized evidenced by an average diagnostic delay of 14–16 years for women who are diagnosed with a congenital bleeding disorder [ 2 Kirtava A. Crudder S. Dilley A. Lally C. Evatt B. Trends in clinical management of women with von Willebrand disease: a survey of 75 women enrolled in haemophilia treatment centers in the United States. Haemophilia. 2004; 10: 158-161 Crossref PubMed Scopus (91) Google Scholar , 3 Atiq F. et al. Major differences in clinical presentation, diagnosis and management of men and women with autosomal inherited bleeding disorders. EClinicalMedicine. 2021; 32: 100726 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. Even in the high resource setting, screening rates for von Willebrand disease, the most common inherited bleeding disorder, are strikingly low, despite ACOG recommendations [ [4] Jacobson A.E. Vesely S.K. Brien S.H.O. Campbell J. Patterns of von Willebrand disease screening in girls and adolescents with heavy menstrual bleeding. Obstet Gynecol. 2018; 131: 1121-1129 Crossref PubMed Scopus (15) Google Scholar ]. Missed diagnosis may lead to social impairment, psychological and physical problems caused by inadequate treatment and subsequent complications.