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Complications of Heavy Menstrual Bleeding in Adolescents

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Hematology in the Adolescent Female

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Abstract

Heavy menstrual bleeding is a very common complaint among adolescents with prevalence rates as high as 37% in this population. Although mortality rates are very low in developed countries where blood products and medications are readily available to manage severe cases, there is significant morbidity, healthcare utilization, and decreased health-related quality of life among adolescents that present with heavy menstrual bleeding.

This chapter explores the most common complications of heavy menstrual bleeding including anemia, complications of medical and surgical treatments, as well as the psychosocial and financial impacts of heavy menstrual bleeding.

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Abbreviations

CHC:

Combined hormonal contraceptives

HMB:

Heavy menstrual bleeding

HRQOL:

Health-related quality of life

References

  1. Committee Opinion No. 651 Summary. Obstet Gynecol. 2015;126(6):1328.

    Google Scholar 

  2. Friberg B, Kristin Örnö A, Lindgren A, Lethagen S. Bleeding disorders among young women: a population-based prevalence study. Acta Obstet Gynecol Scand. 2006;85(2):200–6.

    PubMed  Google Scholar 

  3. Munro MG, Critchley HOD, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011;113(1):3–13.

    Google Scholar 

  4. O’Brien B, Mason J, Kimble R. Bleeding disorders in adolescents with heavy menstrual bleeding: the Queensland Statewide Paediatric and adolescent Gynaecology Service. J Pediatr Adolesc Gynecol. 2019;32(2):122–7.

    PubMed  Google Scholar 

  5. Díaz R, Dietrich JE, Mahoney D, Yee DL, Srivaths LV. Hemostatic abnormalities in young females with heavy menstrual bleeding. J Pediatr Adolesc Gynecol. 2014;27(6):324–9.

    PubMed  Google Scholar 

  6. Mikhail S, Varadarajan R, Kouides P. The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre. Haemophilia. 2007;13(5):627–32.

    CAS  PubMed  Google Scholar 

  7. Iron deficiency–United States, 1999–2000. MMWR Morb Mortal Wkly Rep. 2002;51(40):897–9.

    Google Scholar 

  8. Cooke AG, McCavit TL, Buchanan GR, Powers JM. Iron deficiency anemia in adolescents who present with heavy menstrual bleeding. J Pediatr Adolesc Gynecol. 2017;30(2):247–50.

    PubMed  Google Scholar 

  9. Revel-Vilk S, Paltiel O, Lipschuetz M, et al. Underdiagnosed menorrhagia in adolescents is associated with underdiagnosed anemia. J Pediatr. 2012;160(3):468–72.

    PubMed  Google Scholar 

  10. Johnson S, Lang A, Sturm M, O’Brien SH. Iron deficiency without anemia: a common yet under-recognized diagnosis in young women with heavy menstrual bleeding. J Pediatr Adolesc Gynecol. 2016;29(6):628–31.

    PubMed  Google Scholar 

  11. Global Burden of Disease Pediatrics C, Kyu HH, Pinho C, et al. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: findings from the global burden of disease 2013 study. JAMA Pediatr. 2016;170(3):267–87.

    Google Scholar 

  12. Boccio JR, Iyengar V. Iron deficiency: causes, consequences, and strategies to overcome this nutritional problem. Biol Trace Elem Res. 2003;94(1):1–32.

    CAS  PubMed  Google Scholar 

  13. Jáuregui-Lobera I. Iron deficiency and cognitive functions. Neuropsychiatr Dis Treat. 2014;10:2087–95.

    PubMed  PubMed Central  Google Scholar 

  14. More S, Shivkumar VB, Gangane N, Shende S. Effects of iron deficiency on cognitive function in school going adolescent females in rural area of Central India. Anemia. 2013;2013:–819136.

    Google Scholar 

  15. Rezaeian A, Ghayour-Mobarhan M, Mazloum SR, Yavari M, Jafari S-A. Effects of iron supplementation twice a week on attention score and haematologic measures in female high school students. Singap Med J. 2014;55(11):587–92.

    Google Scholar 

  16. Murray-Kolb LE, Beard JL. Iron treatment normalizes cognitive functioning in young women. Am J Clin Nutr. 2007;85(3):778–87.

    CAS  PubMed  Google Scholar 

  17. Koh K-L, Sonny Teo KS, Chong M-F, Wan Hitam W-H. Non-arteritic anterior ischaemic optic neuropathy secondary to menorrhagia in a young healthy woman. BMJ Case Rep. 2018;2018:bcr2018225113.

    PubMed Central  Google Scholar 

  18. Corrales-Medina FF, Grant L, Egas-Bejar D, Valdivia-Ascuna Z, Rodriguez N, Mancias P. Cerebral Sinovenous thrombosis associated with Iron deficiency anemia secondary to severe menorrhagia. J Child Neurol. 2013;29(9):NP62–4.

    PubMed  Google Scholar 

  19. Healthy People 2020. Foundation Health Measure Report. Health-Related Quality of Life and Well-Being. US Department of Health and Human Services, Office of Disease Prevention and Health Promotion;November 2010.

    Google Scholar 

  20. Shankar M, Chi C, Kadir RA. Review of quality of life: menorrhagia in women with or without inherited bleeding disorders. Haemophilia. 2007;14(1):071027033511001.

    Google Scholar 

  21. Kadir RA, Edlund M, Von Mackensen S. The impact of menstrual disorders on quality of life in women with inherited bleeding disorders. Haemophilia. 2010;16(5):832–9.

    CAS  PubMed  Google Scholar 

  22. Peuranpää P, Heliövaara-Peippo S, Fraser I, Paavonen J, Hurskainen R. Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding. Acta Obstet Gynecol Scand. 2014;93(7):654–60.

    PubMed  Google Scholar 

  23. Rae C, Furlong W, Horsman J, et al. Bleeding disorders, menorrhagia and iron deficiency: impacts on health-related quality of life. Haemophilia. 2013;19(3):385–91.

    CAS  PubMed  Google Scholar 

  24. Nur Azurah AG, Sanci L, Moore E, Grover S. The quality of life of adolescents with menstrual problems. J Pediatr Adolesc Gynecol. 2013;26(2):102–8.

    PubMed  Google Scholar 

  25. Pawar A, Krishnan R, Davis K, Bosma K, Kulkarni R. Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders. Haemophilia. 2008;14(3):579–83.

    CAS  PubMed  Google Scholar 

  26. Limperg PF, Joosten MMH, Fijnvandraat K, Peters M, Grootenhuis MA, Haverman L. Male gender, school attendance and sports participation are positively associated with health-related quality of life in children and adolescents with congenital bleeding disorders. Haemophilia. 2018;24(3):395–404.

    CAS  PubMed  Google Scholar 

  27. Wang W, Bourgeois T, Klima J, Berlan ED, Fischer AN, O'Brien SH. Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding. Haemophilia. 2012;19(2):225–30.

    CAS  PubMed  Google Scholar 

  28. Sharma R, Stanek JR, Koch TL, Grooms L, O’Brien SH. Intravenous iron therapy in non-anemic iron-deficient menstruating adolescent females with fatigue. Am J Hematol. 2016;91(10):973–7.

    CAS  PubMed  Google Scholar 

  29. Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;2(2):–CD000154.

    Google Scholar 

  30. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(3):1–103.

    PubMed  Google Scholar 

  31. Schwallie PC, Assenzo JR. Contraceptive use—efficacy study utilizing medroxyprogesterone acetate* administered as an intramuscular injection once every 90 days*Depo-Provera, Upjohn; sterile aqueous suspension of medroxyprogesterone acetate. Fertil Steril. 1973;24(5):331–9.

    CAS  PubMed  Google Scholar 

  32. Gai L, Zhang J, Zhang H, Gai P, Zhou L, Liu Y. The effect of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) and evaluating changes in BMD after discontinuation of DMPA in Chinese women of reproductive age. Contraception. 2011;83(3):218–22.

    CAS  PubMed  Google Scholar 

  33. Lohr PA, Lyus R, Prager S. Use of intrauterine devices in nulliparous women. Contraception. 2017;95(6):529–37.

    PubMed  Google Scholar 

  34. Adams Hillard PJ. Menstrual suppression with the Levonorgestrel intrauterine system in girls with developmental delay. J Pediatr Adolesc Gynecol. 2012;25(5):308–13.

    Google Scholar 

  35. Patseadou M, Michala L. Usage of the levonorgestrel-releasing intrauterine system (LNG-IUS) in adolescence: what is the evidence so far? Arch Gynecol Obstet. 2016;295(3):529–41.

    PubMed  Google Scholar 

  36. Luukkainen T, Lähteenmäki P, Toivonen J. Levonorgestrel-releasing intrauterine device. Ann Med. 1990;22(2):85–90.

    CAS  PubMed  Google Scholar 

  37. Roy SN, Bhattacharya S. Benefits and risks of pharmacological agents used for the treatment of menorrhagia. Drug Saf. 2004;27(2):75–90.

    CAS  PubMed  Google Scholar 

  38. Bofill Rodriguez M, Lethaby A, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;9(9):–CD000400.

    Google Scholar 

  39. Ozgönenel B, Rajpurkar M, Lusher JM. How do you treat bleeding disorders with desmopressin? Postgrad Med J. 2007;83(977):159–63.

    PubMed  PubMed Central  Google Scholar 

  40. O’Brien SH, Saini S, Ziegler H, et al. An open-label, single-arm, efficacy study of tranexamic acid in adolescents with heavy menstrual bleeding. J Pediatr Adolesc Gynecol. 2019;32(3):305–11.

    PubMed  Google Scholar 

  41. Lukes AS, Moore KA, Muse KN, et al. Tranexamic acid treatment for heavy menstrual bleeding. Obstet Gynecol. 2010;116(4):865–75.

    PubMed  Google Scholar 

  42. Muse K, Lukes AS, Gersten J, Waldbaum A, Mabey RG, Trott E. Long-term evaluation of safety and health-related quality of life in women with heavy menstrual bleeding treated with oral tranexamic acid. Womens Health. 2011;7(6):699–707.

    CAS  Google Scholar 

  43. Carson JL, Triulzi DJ, Ness PM. Indications for and adverse effects of red-cell transfusion. N Engl J Med. 2017;377(13):1261–72.

    PubMed  Google Scholar 

  44. Tolkien Z, Stecher L, Mander AP, Pereira DIA, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015;10(2):–e0117383.

    Google Scholar 

  45. Szebeni J, Fishbane S, Hedenus M, et al. Hypersensitivity to intravenous iron: classification, terminology, mechanisms and management. Br J Pharmacol. 2015;172(21):5025–36.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Bofill Rodriguez M, Lethaby A, Grigore M, Brown J, Hickey M, Farquhar C. Endometrial resection and ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;1:CD001501.

    PubMed  Google Scholar 

  47. Overton C, Hargreaves J, Maresh M. A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. BJOG. 1997;104(12):1351–9.

    CAS  Google Scholar 

  48. Athanatos D, Pados G, Venetis CA, et al. Novasure impedance control system versus microwave endometrial ablation for the treatment of dysfunctional uterine bleeding: a double-blind, randomized controlled trial. Clin Exp Obstet Gynecol. 2015;42(3):347–51.

    CAS  PubMed  Google Scholar 

  49. Laberge PY, Garza-Leal J, Fortin C, et al. A randomized, controlled, multi-center trial of the safety and efficacy of the minerva endometrial ablation system. one-year follow-up results. J Minim Invasive Gynecol. 2016;23(7):S44.

    Google Scholar 

  50. Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2016;

    Google Scholar 

  51. Barnhart KT, Schreiber CA. Return to fertility following discontinuation of oral contraceptives. Fertil Steril. 2009;91(3):659–63.

    PubMed  Google Scholar 

  52. Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018;3:9–9.

    PubMed  PubMed Central  Google Scholar 

  53. Kouides PA, Phatak PD, Burkart P, et al. Gynaecological and obstetrical morbidity in women with type I von Willebrand disease: results of a patient survey. Haemophilia. 2000;6(6):643–8.

    CAS  PubMed  Google Scholar 

  54. James AH. More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders. Haemophilia. 2005;11(4):295–307.

    CAS  PubMed  Google Scholar 

  55. Lak M, Peyvandi F, Mannucci PM. Clinical manifestations and complications of childbirth and replacement therapy in 385 Iranian patients with type 3 von Willebrand disease. Br J Haematol. 2000;111(4):1236–9.

    CAS  PubMed  Google Scholar 

  56. Kirtava A, Drews C, Lally C, Dilley A, Evatt B. Medical, reproductive and psychosocial experiences of women diagnosed with von Willebrand’s disease receiving care in haemophilia treatment centres: a case-control study. Haemophilia. 2003;9(3):292–7.

    CAS  PubMed  Google Scholar 

  57. Gabbe SG, Niebyl JR, Simpson JL. Obstetrics : normal and problem pregnancies. New York: Churchill Livingstone; 2002.

    Google Scholar 

  58. Srivaths LV, Zhang QC, Byams VR, et al. Differences in bleeding phenotype and provider interventions in postmenarchal adolescents when compared to adult women with bleeding disorders and heavy menstrual bleeding. Haemophilia. 2018;24(1):63–9.

    CAS  PubMed  Google Scholar 

  59. Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10(3):183–94.

    PubMed  Google Scholar 

  60. Miller JD, Lenhart GM, Bonafede MM, Basinski CM, Lukes AS, Troeger KA. Cost effectiveness of endometrial ablation with the NovaSure(®) system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives. Int J Women’s Health. 2015;7:59–73.

    Google Scholar 

  61. Blumenthal PD, Trussell J, Singh RH, et al. Cost-effectiveness of treatments for dysfunctional uterine bleeding in women who need contraception. Contraception. 2006;74(3):249–58.

    PubMed  Google Scholar 

  62. Côté I, Jacobs P, Cumming D. Work loss associated with increased menstrual loss in the United States. Obstet Gynecol. 2002;100(4):683–7.

    PubMed  Google Scholar 

  63. Côté I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol. 2003;188(2):343–8.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Hemophilia and Bleeding Disorders Treatment Center, Johns Hopkins All Children’s Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL, USA

    Irmel A. Ayala

  2. Section of Adolescent Medicine, St Christopher’s Hospital for Children, Drexel University, Philadelphia, PA, USA

    Enitan Adegite

Authors
  1. Irmel A. Ayala
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  2. Enitan Adegite
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Corresponding author

Correspondence to Irmel A. Ayala .

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Editors and Affiliations

  1. Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Lakshmi V. Srivaths

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Ayala, I.A., Adegite, E. (2020). Complications of Heavy Menstrual Bleeding in Adolescents. In: Srivaths, L. (eds) Hematology in the Adolescent Female. Springer, Cham. https://doi.org/10.1007/978-3-030-48446-0_9

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  • DOI: https://doi.org/10.1007/978-3-030-48446-0_9

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