Objective

Heavy menstrual bleeding (HMB) is a common clinical condition among adolescents and occurs most often within the first 2–3 years after menarche. Although HMB, which is typically associated with irregular and prolonged menstruation in this age group, is usually caused by anovulatory bleeding due to immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, an underlying, previously undiagnosed bleeding disorder (BD) may also lead to such bleeding. It has been reported that approximately 20% of adolescent girls who present for evaluation of HMB and up to 33% of girls hospitalized for HMB may have BD^1,2. The aim of our study was to investigate the prevalence of BD in a population of adolescents who were evaluated in the emergency setting for HMB and whose hemoglobin values were found to be 8 and below.

Methods

The study was a retrospective review of adolescents aged 10 to 17 years with HMB, who were presented as an emergency to a tertiary Pediatric and Adolescent Gynecology Service between 2017 and 2022 and had hemoglobin values of 8 and below. Patients with a previously diagnosed BD or a medical condition that could cause BD and an underlying gynecological pathology were excluded. Data on menstrual history, bleeding symptoms, hospitalization, blood transfusion, treatments, and screening for BD were evaluated. The institutional review board approval was obtained.

Results

During the study period, there were 46 adolescents who sought care for HMB in the emergency setting and met the inclusion criteria. The mean age at menarche and at the onset of symptoms 11.9±1.4 years and 13.4±1.9 years, respectively.The mean hemoglobin value on presentation was 6.3±1.2 g/dL. The rate of hospitalization for management was 65% (30/46) and 24 patients (52%) received packed red blood cell transfusions. Evaluation for the presence of a bleeding disorder was performed with a screening panel including PT, PTT, INR, von Willebrand Factor activity and antigen, and Factor VIII levels in 39/46 (%85) of the patients. Only one case of von Willebrand disease (VWD) was detected in these patients (Table 1). While all the patients were managed with hormonal therapy and in some cases additional use of antifibrinolytics, no patient required a surgical procedure.

Conclusion

HMB with irregular and prolonged menstruation, especially in adolescents in their first years after menarche might require urgent treatment including inpatient hospital stays and blood transfusions³. Our findings suggest that the immaturity of HPO axis appears to be the only cause that can be found in the vast majority of these cases.

中文翻译：

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出现大量月经出血和需要紧急治疗的急性贫血的初潮后青少年出血性疾病的患病率

客观的

月经大量出血 (HMB) 是青少年常见的临床病症，最常发生在月经初潮后的前 2-3 年内。尽管 HMB 通常与这个年龄组的月经不规律和延长有关，通常是由下丘脑-垂体-卵巢 (HPO) 轴不成熟导致的无排卵性出血引起的，但潜在的、以前未确诊的出血性疾病 (BD) 也可能导致这样的出血。据报道，约有 20% 的青春期女孩出现 HMB 评估，高达 33% 的 HMB 住院女孩可能患有 BD ^1,2。我们研究的目的是调查在紧急情况下接受 HMB 评估且血红蛋白值为 8 及以下的青少年人群中 BD 的患病率。

方法

该研究是对 10 至 17 岁患有 HMB 的青少年的回顾性研究，这些青少年在 2017 年至 2022 年期间作为紧急情况被送往三级儿科和青少年妇科服务，血红蛋白值为 8 及以下。先前诊断出 BD 或有可能导致 BD 的医疗状况和潜在妇科病理的患者被排除在外。对月经史、出血症状、住院、输血、治疗和 BD 筛查的数据进行了评估。获得了机构审查委员会的批准。

结果

在研究期间，有 46 名青少年在紧急情况下寻求 HMB 护理并符合纳入标准。月经初潮和出现症状时的平均年龄分别为 11.9±1.4 岁和 13.4±1.9 岁。就诊时的平均血红蛋白值为 6.3±1.2 g/dL。住院治疗率为 65% (30/46)，24 名患者 (52%) 接受浓缩红细胞输注。在 39/46 (%85) 的患者中，使用包括 PT、PTT、INR、von Willebrand 因子活性和抗原以及因子 VIII 水平的筛查组评估是否存在出血性疾病。在这些患者中仅检测到一例血管性血友病 (VWD)（表 1）。虽然所有患者都接受了激素治疗，在某些情况下还额外使用了抗纤维蛋白溶解药，

结论

HMB 伴月经不规律和延长，尤其是在初潮后头几年的青少年可能需要紧急治疗，包括住院和输血³。我们的研究结果表明，HPO 轴的不成熟似乎是绝大多数此类病例中可以找到的唯一原因。