Abstract
Heavy, and often irregular, menstrual bleeding (HMB) is a common gynecologic complaint
among adolescents. During the first few post-menarcheal years, anovulatory cycles
related to immaturity of the hypothalamic–pituitary–ovarian axis are the most common
etiology for abnormal uterine bleeding and should be considered as a part of normal
pubertal development rather than a disease. If an already regular menstrual cycle
becomes irregular, secondary causes of anovulation should be ruled out. Inherited
and acquired bleeding disorders, such as von Willebrand disease, and quantitative
and qualitative abnormalities of platelets are relatively common findings in adolescents
with HMB from menarche. History of excessive bleeding or a diagnosed bleeding disorder
in the family supports this etiology, warranting specialized laboratory testing. First-line
treatment of HMB among adolescents is medical management with hormonal therapy or
nonhormonal options. Levonorgestrel-releasing intrauterine device is an effective
tool also for all adolescents with menstrual needs.
Keywords
adolescent - menorrhagia - anovulation - von Willebrand disease - hormonal treatment
