Bleeding disorders: A common cause of menorrhagia in adolescents

Objective: To determine the frequency of underlying bleeding disorders in a dolescents with menorrhagia. Study design: We retrospectively reviewed the charts of all girls, aged IO to 19 years, who presented to our children's hospital for inpatient or outp atient evaluation of menorrhagia between January 1990 and November 1998. Results: At presentation, 9 of the 71 girls (13%) had thrombocytopenia (pla telet count <150.000/<mu>L; range, 5000-106,000/muL). The most common cause s for thrombocytopenia were immune thrombocytopenic purpura (n = 5) and mye losuppression caused by chemotherapy (n = 2). Of 14 girls who underwent a m ore detailed hemostatic evaluation, 8 were given a diagnosis of a hereditar y coagulation disorder: 6 had platelet function defects and 2 had type 1 vo n Willebrand disease. Excessive menstrual bleeding commonly results in anem ia. One half of the total group had anemia (hemoglobin <12.0 g/dL). Seven g irls (10%) had potentially life-threatening anemia (hemoglobin <5.0 g/dL). Conclusions: Acquired and congenital bleeding disorders are common causes o f menorrhagia in adolescent girls. Severe anemia is a frequent complication of menorrhagia. We recommend that adolescents without thrombocytopenia who present with menorrhagia receive a comprehensive hemostatic evaluation, in cluding testing fbr von Willebrand disease and platelet function defects.