Heavy Menstrual Bleeding: What Girls (and Parents) Need to Know

Heavy menstrual bleeding is a common problem during adolescence.  In fact, almost 50% of women report having heavy periods at some point during their reproductive years. Heavy menstrual bleeding can negatively impact quality of life, school attendance, and participation in after-school sports and activities.

However, just because it is a common problem doesn’t make it an easy topic for young women to discuss with parents or health care providers. Girls and parents often have difficulty assessing what constitutes normal menstrual cycles or patterns of bleeding.

Patients and health care providers should consider a diagnosis of heavy menstrual bleeding when any of the following symptoms occur:

  • Menses last more than seven days
  • Bleeding is heavy enough to soak through a pad or tampon in 1-2 hours. School attendance or sports/activity participation is impacted by the challenges of menstrual hygiene
  • Patient alters her social schedule or plan events according to her menstrual cycle
  • Patient has experienced “flooding,” with unexpected onset of flow “like turning on a faucet” or which includes the passage of blood clots larger than 1 inch in diameter (about the size of a quarter)
  • Menses associated with iron deficiency, with or without anemia

Hematologists have an interest in heavy menstrual bleeding because it is the most common symptom reported by women with underlying bleeding disorders.  And when heavy periods “run in the family” teens may perceive their heavy menstrual bleeding to be normal.

Many of the young women we see in our clinics have iron deficiency or iron deficiency anemia, a common complication of heavy menstrual bleeding.  Dietary changes and use of oral iron supplements are always the first line of intervention for such patients. For symptomatic patients not responding to oral therapy, or who experience intolerable side effects from oral iron, intravenous iron is a potential option that we offer to our patients.

Typically, the bleeding disorders we diagnose in our Young Women’s Hematology clinic are referred to as mild bleeding disorders. They include deficiencies of certain clotting factors or poor clotting function by the platelet cells in the blood system.

Girls with substantial joint hypermobility (who are often dancers, gymnasts, or cheerleaders due to their flexibility skills) may be at increased risk of bruising/bleeding. As symptoms of these common bleeding disorders in girls can be mild, heavy menstrual bleeding may be the first or only clinical manifestation. Other common symptoms of bleeding disorders in children include easy or unexplained bruising and nosebleeds.

Undiagnosed bleeding disorders can cause bleeding after accidents, injuries, childbirth, minor surgery or even dental work. Adverse outcomes of bleeding disorders can be prevented or controlled with treatment, enhancing the patient’s safety and quality of life.

One of the goals of Healthy People 2020 is to increase the proportion of health care providers who refer women with symptoms suggestive of inherited bleeding disorders for diagnosis and treatment.

Encouraging young women to give their health care provider an accurate description of their menstrual cycles, and to freely share any concerns regarding the duration or heaviness of their menstrual bleeding, are the first steps in this important initiative.

Click here for more information on heavy menstrual bleeding or listen to our PediaCast.

Sarah O'Brien, MD
Dr. O’Brien’s clinical and research interests include pediatric thrombosis and thromboprophylaxis, the evaluation and diagnosis of mild bleeding disorders, and the intersections between hematology and women’s health. She also leads a multidisciplinary hematology and adolescent gynecology clinic at Nationwide Children’s. As a health services researcher, Dr. O’Brien has a particular interest in the use of large administrative databases, as well as decision analysis and cost effectiveness analysis. She attended the University of Pittsburgh School of Medicine and received her residency and fellowship training from Children’s Hospital of Pittsburgh of UPMC. Dr. O’Brien is voted among the “Best Doctors in America”.

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