Current Pediatrics Reports

, Volume 6, Issue 2, pp 123–131 | Cite as

Abnormal Uterine Bleeding in Adolescent Women

  • Eric S. Mullins
  • Rachel J. Miller
  • Tanya L. Kowalczyk Mullins
Adolescent Medicine (M Goldstein and L Johnson, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Adolescent Medicine


Purpose of Review

To review the current state of terminology, evaluation, and management of abnormal uterine bleeding (AUB) in adolescents.

Recent Findings

The current terminology classifies the causes of AUB under the mnemonic “PALM-COEIN”: Polyps, Adenomyosis, Leiomyoma, Malignancy/hyperplasia; Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified. Heavy menstrual bleeding (HMB) is one manifestation of AUB. Complete menstrual, gynecologic, medical, and family histories, together with a thorough physical exam, are critical to the determination of the underlying cause of AUB. Initial laboratory testing should be guided by the findings of history and physical. Hormonal therapy is the mainstay of acute and chronic management of AUB. Hemostatic treatments could be considered.


The primary management for AUB is with hormonal medications. Further studies of combining estrogen-containing hormonal management and hemostatic therapies (such as tranexamic acid) are needed given the theoretical concerns about increased risk of thromboembolism in women with difficult to manage AUB.


Abnormal uterine bleeding Heavy menstrual bleeding Adolescent Bleeding disorder evaluation 


Compliance with Ethical Standards

Conflict of Interest

Rachel J. Miller and Tanya L. Kowalczyk Mullins declare no conflicts of interest.

Eric Mullins reports personal fees from Shire, personal fees from Bayer, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO working group on menstrual disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3–13. Key paper describing the FIGO classification system of abnormal uterine bleeding. CrossRefPubMedGoogle Scholar
  2. 2.
    American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891–6. Scholar
  3. 3.
    •• American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 651: menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstet Gynecol. 2015;126(6):e143–6. Concise review of normal adolescent menses; endorsed by the American Academy of Pediatrics. CrossRefGoogle Scholar
  4. 4.
    Hallberg L, Hogdahl AM, Nilsson L, Rybo G. Menstrual blood loss and iron deficiency. Acta Med Scand. 1966;180(5):639-50. As cited in Bitzer J., Heikinheimo, O., Nelson, A., et al. Medical management of heavy menstrual bleeding: a comprehensive review of the literature. Obstet Gynecol Survey. 2015;70:115–30.CrossRefGoogle Scholar
  5. 5.
    Bitzer J, Heikinheimo O, Nelson AL, Calaf-Alsina J, Fraser IS. Medical management of heavy menstrual bleeding: a comprehensive review of the literature. Obstet Gynecol Surv. 2015;70(2):115–30. Scholar
  6. 6.
    Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol. 2012;207(4):259–65. Scholar
  7. 7.
    • Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol. 2004;190(5):1216–23. Important study describing factors associated with heavy menstrual bleeding. CrossRefPubMedGoogle Scholar
  8. 8.
    Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97(8):734-9; As cited in Zia, A. and Rajpurkar, M. Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thromb Res. 2016;143:91–100.CrossRefGoogle Scholar
  9. 9.
    Zia A, Rajpurkar M. Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thromb Res. 2016;143:91–100. Scholar
  10. 10.
    Janssen CA, Scholten PC, Heintz AP. A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Obstet Gynecol. 1995;85(6):977–82. Scholar
  11. 11.
    Zakherah MS, Sayed GH, El-Nashar SA, Shaaban MM. Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: diagnostic accuracy compared to alkaline hematin. Gynecol Obstet Investig. 2011;71(4):281–4. Scholar
  12. 12.
    Sanchez J, Andrabi S, Bercaw JL, Dietrich JE. Quantifying the PBAC in a pediatric and adolescent gynecology population. Pediatr Hematol Oncol. 2012;29(5):479–84. Scholar
  13. 13.
    Billow MR, El-Nashar SA. Management of abnormal uterine bleeding with emphasis on alternatives to hysterectomy. Obstet Gynecol Clin N Am. 2016;43(3):415–30. Scholar
  14. 14.
    •• Haamid F, Sass AE, Dietrich JE. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol. 2017;30(3):335–40. NASPAG Committee Opinion on evaluation and management of heavy menstrual bleeding in adolescents. CrossRefPubMedGoogle Scholar
  15. 15.
    Mullins TL, Miller RJ, Mullins ES. Evaluation and management of adolescents with abnormal uterine bleeding. Pediatr Ann. 2015;44(9):e218–22. Scholar
  16. 16.
    Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017;40:3–22. Scholar
  17. 17.
    Talib HJ, Coupey SM. Excessive uterine bleeding. Adolesc Med State Art Rev. 2012;23(1):53–72.PubMedGoogle Scholar
  18. 18.
    Pecchioli Y, Oyewumi L, Allen LM, Kives S. The utility of routine ultrasound in the diagnosis and management of adolescents with abnormal uterine bleeding. J Pediatr Adolesc Gynecol. 2017;30(2):239–42. Scholar
  19. 19.
    Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic review. BJOG. 2004;111(7):734–40. Scholar
  20. 20.
    Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood. 1987;69(2):454–9.PubMedGoogle Scholar
  21. 21.
    Werner EJ, Broxson EH, Tucker EL, Giroux DS, Shults J, Abshire TC. Prevalence of von Willebrand disease in children: a multiethnic study. J Pediatr. 1993;123(6):893–8.CrossRefPubMedGoogle Scholar
  22. 22.
    •• Byams VR, Kouides PA, Kulkarni R, Baker JR, Brown DL, Gill JC, et al. Surveillance of female patients with inherited bleeding disorders in United States Haemophilia Treatment Centres. Haemophilia. 2011;17(Suppl 1):6–13. Discusses the bleeding symptoms, diagnosis, and treatment of women followed in Hemophilia Treatment Centers. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    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 centres in the United States. Haemophilia. 2004;10(2):158–61.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    Friberg B, Orno AK, Lindgren A, Lethagen S. Bleeding disorders among young women: a population-based prevalence study. Acta Obstet Gynecol Scand. 2006;85(2):200–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynaecol Obstet. 2015;128(3):196–200. Scholar
  27. 27.
    Sramek A, Eikenboom JC, Briet E, Vandenbroucke JP, Rosendaal FR. Usefulness of patient interview in bleeding disorders. Arch Intern Med. 1995;155(13):1409–15.CrossRefPubMedGoogle Scholar
  28. 28.
    Philipp CS, Faiz A, Dowling NF, Beckman M, Owens S, Ayers C, et al. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol. 2008;198(2):163 e1–8. Scholar
  29. 29.
    •• Philipp CS, Faiz A, Heit JA, Kouides PA, Lukes A, Stein SF, et al. Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia. Am J Obstet Gynecol. 2011;204(3):209 e1–7. Screening tool that details the most pertinent historical questions for evaluation of a bleeding disorder in women. CrossRefGoogle Scholar
  30. 30.
    James AH, Kouides PA, Abdul-Kadir R, Edlund M, Federici AB, Halimeh S, et al. Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. 2009;201(1):12 e1–8. Scholar
  31. 31.
    Leach M. Interpretation of the full blood count in systemic disease—a guide for the physician. J R Coll Physicians Edinb. 2014;44(1):36–41. Scholar
  32. 32.
    Bessman JD, Feinstein DI. Quantitative anisocytosis as a discriminant between iron deficiency and thalassemia minor. Blood. 1979;53(2):288–93.PubMedGoogle Scholar
  33. 33.
    Morris VK, Spraker HL, Howard SC, Ware RE, Reiss UM. Severe thrombocytopenia with iron deficiency anemia. Pediatr Hematol Oncol. 2010;27(5):413–9. Scholar
  34. 34.
    Perlman MK, Schwab JG, Nachman JB, Rubin CM. Thrombocytopenia in children with severe iron deficiency. J Pediatr Hematol Oncol. 2002;24(5):380–4.CrossRefPubMedGoogle Scholar
  35. 35.
    Kasper CK, Whissell DY, Wallerstein RO. Clinical aspects of iron deficiency. JAMA. 1965;191:359–63.CrossRefPubMedGoogle Scholar
  36. 36.
    Hoffman M, Monroe DM 3rd, Roberts HR. Activated factor VII activates factors IX and X on the surface of activated platelets: thoughts on the mechanism of action of high-dose activated factor VII. Blood Coagul Fibrinolysis. 1998;9(Suppl 1):S61–5.PubMedGoogle Scholar
  37. 37.
    Male C, Lechner K, Eichinger S, Kyrle PA, Kapiotis S, Wank H, et al. Clinical significance of lupus anticoagulants in children. J Pediatr. 1999;134(2):199–205.CrossRefPubMedGoogle Scholar
  38. 38.
    Koenig S, Gerstner T, Keller A, Teich M, Longin E, Dempfle CE. High incidence of vaproate-induced coagulation disorders in children receiving valproic acid: a prospective study. Blood Coagul Fibrinolysis. 2008;19(5):375–82. Scholar
  39. 39.
    Schneppenheim R, von Budde U. Willebrand factor: the complex molecular genetics of a multidomain and multifunctional protein. J Thromb Haemost. 2011;9(Suppl 1):209–15. CrossRefPubMedGoogle Scholar
  40. 40.
    Sadler JE, Budde U, Eikenboom JC, Favaloro EJ, Hill FG, Holmberg L, et al. Update on the pathophysiology and classification of von Willebrand disease: a report of the Subcommittee on von Willebrand Factor. J Thromb Haemost. 2006;4(10):2103–14. Scholar
  41. 41.
    Rodeghiero F, Castaman G, Tosetto A. von Willebrand factor antigen is less sensitive than ristocetin cofactor for the diagnosis of type I von Willebrand disease—results based on an epidemiological investigation. Thromb Haemost. 1990;64(3):349–52.PubMedGoogle Scholar
  42. 42.
    Kadir RA, Economides DL, Sabin CA, Owens D, Lee CA. Variations in coagulation factors in women: effects of age, ethnicity, menstrual cycle and combined oral contraceptive. Thromb Haemost. 1999;82(5):1456–61.CrossRefPubMedGoogle Scholar
  43. 43.
    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. Scholar
  44. 44.
    Knol HM, Mulder AB, Bogchelman DH, Kluin-Nelemans HC, van der Zee AG, Meijer K. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities. Am J Obstet Gynecol. 2013;209(3):202 e1–7. Scholar
  45. 45.
    Philipp CS, Dilley A, Miller CH, Evatt B, Baranwal A, Schwartz R, et al. Platelet functional defects in women with unexplained menorrhagia. J Thromb Haemost. 2003;1(3):477–84.CrossRefPubMedGoogle Scholar
  46. 46.
    Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, et al. PFA-100 system: a new method for assessment of platelet dysfunction. Semin Thromb Hemost. 1998;24(2):195–202. Scholar
  47. 47.
    Schwartz L, Brister SJ, Bourassa MG, Peniston C, Buchanan MR. Interobserver reproducibility and biological variability of the Surgicutt II bleeding time. J Thromb Thrombolysis. 1998;6(2):155–8. CrossRefPubMedGoogle Scholar
  48. 48.
    Hayward CP, Harrison P, Cattaneo M, Ortel TL, Rao AK, et al. Platelet function analyzer (PFA)-100 closure time in the evaluation of platelet disorders and platelet function. J Thromb Haemost. 2006;4(2):312–9. Scholar
  49. 49.
    Quiroga T, Goycoolea M, Munoz B, Morales M, Aranda E, Panes O, et al. Template bleeding time and PFA-100 have low sensitivity to screen patients with hereditary mucocutaneous hemorrhages: comparative study in 148 patients. J Thromb Haemost. 2004;2(6):892–8. Scholar
  50. 50.
    Podda GM, Bucciarelli P, Lussana F, Lecchi A, Cattaneo M. Usefulness of PFA-100 testing in the diagnostic screening of patients with suspected abnormalities of hemostasis: comparison with the bleeding time. J Thromb Haemost. 2007;5(12):2393–8. Scholar
  51. 51.
    Naik S, Teruya J, Dietrich JE, Jariwala P, Soundar E, Venkateswaran L. Utility of platelet function analyzer as a screening tool for the diagnosis of von Willebrand disease in adolescents with menorrhagia. Pediatr Blood Cancer. 2013;60(7):1184–7. Scholar
  52. 52.
    Philipp CS, Miller CH, Faiz A, Dilley A, Michaels LA, Ayers C, et al. Screening women with menorrhagia for underlying bleeding disorders: the utility of the platelet function analyser and bleeding time. Haemophilia. 2005;11(5):497–503. Scholar
  53. 53.
    Gresele P. Subcommittee on Platelet Physiology of the International Society on Thrombosis and Hemostasis. Diagnosis of inherited platelet function disorders: guidance from the SSC of the ISTH. J Thromb Haemost. 2015;13(2):314–22. CrossRefPubMedGoogle Scholar
  54. 54.
    •• Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(3):1–103. Critical resource for prescribing any hormonal contraceptive methods. CrossRefGoogle Scholar
  55. 55.
    Bennett AR, Gray SH. What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents. Curr Opin Pediatr. 2014;26(4):413–9. Scholar
  56. 56.
    Mitan LAP, Slap GB. Dysfunctional uterine bleeding. In: Neinstein LS, Gordon CM, Katzman DK, Rosen DS, Woods ER, editors. Adolescent health care: a practical guide. 5th ed: Lippincott Williams and Wilkins; 2007.Google Scholar
  57. 57.
    Lethaby A, Irvine G, Cameron I. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2008;1:CD001016. Scholar
  58. 58.
    Munro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006;108(4):924–9. Scholar
  59. 59.
    Abu Hashim H, Alsherbini W, Bazeed M. Contraceptive vaginal ring treatment of heavy menstrual bleeding: a randomized controlled trial with norethisterone. Contraception. 2012;85(3):246–52. Scholar
  60. 60.
    Kaser DJ, Missmer SA, Berry KF, Laufer MR. Use of norethindrone acetate alone for postoperative suppression of endometriosis symptoms. J Pediatr Adolesc Gynecol. 2012;25(2):105–8. Scholar
  61. 61.
    Hubacher D, Lopez L, Steiner MJ, Dorflinger L. Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons. Contraception. 2009;80(2):113–8. Scholar
  62. 62.
    Dilbaz B, Ozdegirmenci O, Caliskan E, Dilbaz S, Haberal A. Effect of etonogestrel implant on serum lipids, liver function tests and hemoglobin levels. Contraception. 2010;81(6):510–4. Scholar
  63. 63.
    Casey PM, Long ME, Marnach ML, Bury JE. Bleeding related to etonogestrel subdermal implant in a US population. Contraception. 2011;83(5):426–30. Scholar
  64. 64.
    Hohmann H, Creinin MD. The contraceptive implant. Clin Obstet Gynecol. 2007;50(4):907–17. Scholar
  65. 65.
    Merck. Nexplanon (etonogestrel implant) FDA Package Labeling. Available online at Accessed on 2/9/18.
  66. 66.
    Power J, French R, Cowan F. Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy. Cochrane Database Syst Rev. 2007;3:CD001326. Scholar
  67. 67.
    Committee on Practice Bulletins-Gynecology, Long-Acting Reversible Contraception Work Group. Practice Bulletin No. 186: long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2017;130(5):e251–e69. Scholar
  68. 68.
    Bayer Health Care Pharmaceuticals Inc. Mirena (levonorgestrel-releasing intrauterine system) FDA Package Labeling. Available online at Accessed on 1/27/18.
  69. 69.
    Odyssea Pharma SPRL Inc. (affiliated company of Allergan USA). Liletta (levonorgestrel-releasing intrauterine system) FDA Package Labeling. Available online at Accessed on 1/27/18.
  70. 70.
    Bayer Health Care Pharmaceuticals Inc. Kyleena (levonorgestrel-releasing intrauterine system) FDA Package Labeling. Available online at Accessed on 1/27/18.
  71. 71.
    Bayer Health Care Pharmaceuticals Inc. Skyla (levonorgestrel-releasing intrauterine system) FDA Package Labeling. Available online at Accessed on 1/27/18.
  72. 72.
    Varma R, Sinha D, Gupta JK. Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS)—a systematic enquiry and overview. Eur J Obstet Gynecol Reprod Biol. 2006;125(1):9–28. Scholar
  73. 73.
    •• Lethaby A, Hussain M, Rishworth JR, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015;(4):CD002126. Cochrane systematic review comparing progesterone-only methods specifically for HMB.
  74. 74.
    Gupta J, Kai J, Middleton L, Pattison H, Gray R, Daniels J, et al. Levonorgestrel intrauterine system versus medical therapy for menorrhagia. N Engl J Med. 2013;368(2):128–37. Scholar
  75. 75.
    Committee on Practice Bulletins—Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013;122(1):176–85. Scholar
  76. 76.
    Kingman CE, Kadir RA, Lee CA, Economides DL. The use of levonorgestrel-releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders. BJOG. 2004;111(12):1425–8.CrossRefPubMedGoogle Scholar
  77. 77.
    Callender ST, Warner GT, Cope E. Treatment of menorrhagia with tranexamic acid. A double-blind trial. Br Med J. 1970;4(5729):214–6.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Nilsson L, Rybo G. Treatment of menorrhagia with epsilon aminocaproic acid. A double blind investigation. Acta Obstet Gynecol Scand. 1965;44(3):467–73.CrossRefPubMedGoogle Scholar
  79. 79.
    Lukes AS, Moore KA, Muse KN, Gersten JK, Hecht BR, Edlund M, et al. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol. 2010;116(4):865–75. Scholar
  80. 80.
    Kouides PA, Byams VR, Philipp CS, Stein SF, Heit JA, Lukes AS, et al. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. Br J Haematol. 2009;145(2):212–20. Scholar
  81. 81.
    Gleeson N, Devitt M, Sheppard BL, Bonnar J. Endometrial fibrinolytic enzymes in women with normal menstruation and dysfunctional uterine bleeding. Br J Obstet Gynaecol. 1993;100(8):768–71.CrossRefPubMedGoogle Scholar
  82. 82.
    Edlund M, Blomback M, He S. On the correlation between local fibrinolytic activity in menstrual fluid and total blood loss during menstruation and effects of desmopressin. Blood Coagul Fibrinolysis. 2003;14(6):593–8. CrossRefPubMedGoogle Scholar
  83. 83.
    Wiewel-Verschueren S, Knol HM, Lisman T, Bogchelman DH, Kluin-Nelemans JC, van der Zee AG, et al. No increased systemic fibrinolysis in women with heavy menstrual bleeding. J Thromb Haemost. 2014;12(9):1488–93. Scholar
  84. 84.
    Freeman EW, Lukes A, VanDrie D, Mabey RG, Gersten J, Adomako TL. A dose-response study of a novel, oral tranexamic formulation for heavy menstrual bleeding. Am J Obstet Gynecol. 2011;205(4):319 e1–7. Scholar
  85. 85.
    Mannucci PM, Ruggeri ZM, Pareti FI, Capitanio A. 1-Deamino-8-d-arginine vasopressin: a new pharmacological approach to the management of haemophilia and von Willebrands’ diseases. Lancet. 1977;1(8017):869–72.CrossRefPubMedGoogle Scholar
  86. 86.
    Kobayashi I. Treatment of hemophilia A and von Willebrand’s disease patients with an intranasal dripping of DDAVP. Thromb Res. 1979;16(5–6):775–9.CrossRefPubMedGoogle Scholar
  87. 87.
    Kobrinsky NL, Israels ED, Gerrard JM, Cheang MS, Watson CM, Bishop AJ, et al. Shortening of bleeding time by 1-deamino-8-D-arginine vasopressin in various bleeding disorders. Lancet. 1984;1(8387):1145–8.CrossRefPubMedGoogle Scholar
  88. 88.
    Schulman S, Johnsson H, Egberg N, Blomback M. DDAVP-induced correction of prolonged bleeding time in patients with congenital platelet function defects. Thromb Res. 1987;45(2):165–74.CrossRefPubMedGoogle Scholar
  89. 89.
    Cuthbert RJ, Watson HH, Handa SI, Abbott I, Ludlam CA. DDAVP shortens the bleeding time in Bernard-Soulier syndrome. Thromb Res. 1988;49(6):649–50.CrossRefPubMedGoogle Scholar
  90. 90.
    Kadir RA, Lee CA, Sabin CA, Pollard D, Economides DL. DDAVP nasal spray for treatment of menorrhagia in women with inherited bleeding disorders: a randomized placebo-controlled crossover study. Haemophilia. 2002;8(6):787–93.CrossRefPubMedGoogle Scholar
  91. 91.
    Edlund M, Blomback M, Fried G. Desmopressin in the treatment of menorrhagia in women with no common coagulation factor deficiency but with prolonged bleeding time. Blood Coagul Fibrinolysis. 2002;13(3):225–31.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Eric S. Mullins
    • 1
    • 2
  • Rachel J. Miller
    • 3
    • 4
  • Tanya L. Kowalczyk Mullins
    • 2
    • 5
  1. 1.Division of Hematology, Cancer and Blood Diseases InstituteCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.University of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Pediatric and Adolescent GynecologyChildren’s Hospitals and Clinics of MinnesotaMinneapolisUSA
  4. 4.Department of Obstetrics, Gynecology and Women’s HealthUniversity of MinnesotaMinneapolisUSA
  5. 5.Division of Adolescent and Transition MedicineCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations