49. Menstrual Dysfunction And Treatment Among Adolescents With Congenital Heart Disease

Abstract

With increasing survival rates, adolescents with congenital heart disease (CHD) may have more frequent and different reproductive health needs from the general population, and subspecialty clinics are often not equipped to address these needs. These analyses describe menstrual dysfunction and treatment among adolescent females with CHD. Girls and young women, 14-21 years old, (N=100) who could independently complete an on-line questionnaire were recruited from cardiology clinics. Participants completed a survey that assessed their reproductive health status and treatment as it relates to their cardiac lesion(s). Our outcome measures were self-reported menstrual complaints (three items: dysmenorrhea, irregular periods or heavy periods), reported use of over the counter (OTC) pain relief such as acetaminophen, ibuprofen, or naproxen for dysmenorrhea, reported visit with a clinician (doctor or nurse) for a menstrual problem, reports of using hormones (birth control pills, estrogen, progestin, etc.) for a menstrual problem or for puberty, and ever use or current use of birth control. Descriptive statistics were used to characterize the frequency of events and bivariate analyses were conducted to examine associations with reported events. Mean age was 17.7 years (SD 2.2); 91% were white. Cardiac lesions were grouped by complexity: 26% with simple lesions, 40% with moderately complex lesions and 34% with complex lesions. Ten percent reported a heart transplant. A majority (83%) reported one or more menstrual complaints; 71% cramping, 44% irregular menses, 49% heavy periods and 88% reported any history of taking OTC pain relief. The patients who had menstrual complaints were significantly more likely to report use of OTC pain relief, (X2= 5.88, p =.02). Warfarin use was reported in 6% (N=3) of girls who reported heavy menstrual bleeding (n=49). Level of complexity and reported transplant were not associated with increased menstrual complaints (X2= 2.276, p =.13). Although 30% reported seeing a clinician for a menstrual problem, there was no association with actual self-reported menstrual problem (p =.222)-. Lesion complexity was associated with increased likelihood of seeing a clinician for a menstrual problem (X2= 7.22, p =.03). Almost a third (32%) of patients report having taken any hormones for menstrual problem or for puberty. Those with menstrual complaints were not more likely to report use of hormonal contraception (34% vs 35%, X2= 0.15, p =.902). However, girls who reported having sex were more likely to report using a birth control method (68% vs 17%, X2= 26.0, p <.0005). A large majority of girls and young women with CHD reported menstrual dysfunction (83%). The overall proportion is consistent with reports of general populations of adolescents. However, heavy menstrual bleeding reports were higher (49%) and high use of OTC medication for menstrual pain creates concerns that menstrual disorders may be inadequately addressed. Thus gynecological needs of the adolescents with CHD may need to be specifically targeted by providers that feel comfortable with this population and their sometimes complex needs. Research reported in this abstract was supported by a postdoctoral training grant (T32) of the National Institutes of Health under award number 2T32GM008425-26.