Adolescents with heavy menstrual bleeding appear to have a high prevalence of bleeding disorders, according to study results published in Haematologica.

Between July 2014 and December 2017, investigators prospectively enrolled adolescents with anovulatory and ovulatory bleeding to describe their bleeding frequency, predictors, and time from bleeding onset to bleeding disorder diagnosis. Diagnosis of a bleeding disorder was the primary outcome.

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Among 200 participants with a median age of 15 years, 67 (33%) were diagnosed with a bleeding disorder. Of those diagnosed, 29 (43%) had heavy menstrual bleeding as the sole complaint. The diagnoses included low von Willebrand factor levels (38/67; 57%), von Willebrand disease (17/67; 25%), and qualitative platelet dysfunction (9/67; 13.5%). Coagulation factor deficiencies were identified in 2 participants: 1 had mild factor VIII deficiency and 1 had mild factor XIII deficiency. Between the ovulatory and anovulatory bleeding groups, the prevalence of a bleeding disorder was similar (31% vs 36%; P =.45).

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There were 4 predictors associated with bleeding disorder diagnosis: younger age at first bleed (odds ratio [OR], 0.83; 95% CI, 0.73-0.96; P =.011), Hispanic ethnicity (OR, 2.48; 95% CI, 1.13-5.05; P =.021), nonpresentation to emergency department for heavy bleeding (OR, 0.14; 95% CI, 0.05-0.38; P <.0001), and a score of 4 or higher on the International Society on Thrombosis and Hemostasis (ISTH) Bleeding Assessment Tool (BAT; OR, 8.27; 95% CI, 2.60-26.44; P =.0004).

Time from bleeding onset to diagnosis was significantly different between the anovulatory and ovulatory bleeding groups (2 years and 6 years, respectively; P <.001).

The authors concluded that “a high awareness, irrespective of the type of menstrual bleeding, is paramount to identify adolescents with bleeding disorders” and suggested that “the pediatric cutoff for an abnormal ISTH BAT score needs to be revisited for the adolescent age group.”


1.     Zia A, Jain S, Kouides P, et al. Bleeding disorders in adolescents with heavy menstrual bleeding in a multicentre prospective US cohort [published online october 17, 2019]. Haematologica. doi:10.3324/haematol.2019.225656