Most adolescents who seek emergency medical care for heavy menstrual bleeding (HMB) do not require treatment, but up to one-third of patients admitted for HMB may have an underlying bleeding disorder, according to research published in the Journal of Pediatric and Adolescent Gynecology.

HMB is defined as menstrual bleeding lasting longer than 7 days or where more than 80mL of blood is lost in a single cycle. HMB is often not clinically significant, with many patients who present at an emergency department being discharged without medication. However, it can signify the presence of an underlying bleeding disorder or iron deficiency anemia.

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Researchers conducted a retrospective study to assess patient characteristics associated with seeking emergency care for HMB. In particular, the researchers were interested in enumerating severity, cause, and clinical course of bleeding in these patients, as well as evaluating differences between patients admitted to the hospital after presenting at an emergency department and those discharged.

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Of the 258 adolescent patients identified who sought emergency care for HMB between 2006 and 2018, 214 (83%) were discharged and 44 (17%) were admitted. Bleeding cause was anovulation in 56% of all cases, regardless of admission status.

Patients who were admitted tended to be younger (15 vs 17 years; P <.001) and to have lower mean hemoglobin levels (6.3 g/dL vs 12 g/dL; P <.0001) compared with patients who were discharged. Of those discharged, 77% did not require medication.

The majority (73%) of patients admitted for HMB did not have an underlying bleeding disorder. The 12 (27%) patients with an underlying bleeding disorder sought emergency care sooner than did those without a bleeding disorder (5 vs 20 days; P <.03).

“Many adolescents use the emergency department for perceived abnormal vaginal bleeding that is not necessarily clinically relevant and does not necessitate emergency department-level evaluation and care,” the researchers concluded. “Clinicians should discuss appropriate bleeding parameters with all young women — with or without a bleeding disorder — to prevent unnecessary emergency department visits, as well as significant anemia from heavy periods.”


1.     Rosen MW, Weyand AC, Pennesi CM, et al. Adolescents presenting to the emergency department with heavy menstrual bleeding [published online November 22, 2019]. J Pediatr Adolesc Gynecol. doi:10.1016/j.jpag.2019.11.010