Treatment of Heavy Menstrual Bleeding in a Multidisciplinary Young Women's Bleeding Clinic for Adolescents: An Institutional 2-year Experience

On Monday, Megan Brown, M.D., of Emory University in Atlanta, GA, presented results from a retrospective cohort study, which looked at records of young women seen in the Children's Healthcare of Atlanta Comprehensive Women's Bleeding Disorder clinic from 2018 to 2019. Brown commented that the purpose of her study was to characterize the management of adolescent girls with inherited bleeding disorders. Why? Heavy menstrual bleeding (HMB) is a common presenting symptom for an inherited bleeding disorder, and menarche (the first occurrence of menstruation) is often the first hemostatic challenge for a female. The optimal management of HMB in adolescents with inherited bleeding disorders requires collaboration between hematologists and gynecologists. The bleeding disorder clinic from which records were collected served as a prime candidate to provide the framework to allow a collaborative multidisciplinary approach amongst providers.

Brown observed that of the 35 adolescents with bleeding disorders, their median age was 15.5, with more than half being white. The median age of menarche was 11, with median onset of HMB at 12 years. HMB commonly presented at time of menarche, but a delay up to five years was reported. Eleven had medical comorbidities complicating bleeding and clotting risk. The most common initial menstrual reduction therapy utilized was combined oral contraceptives at 58.8%. The majority failed their initial menstrual reduction strategy (64.7%), taking a median number of two additional strategies prior to achieving optimal menstrual suppression. Two subjects with severe type 1 VWD achieved optimal suppression using VWF concentrate infusions during the week of menses after failing multiple alternative therapies. This led Brown to conclude that the ideal medical strategy remains a challenge, often requiring multiple different medical therapies prior to obtaining adequate menstrual control.