Heavy periods in adolescence are a common problem faced by many young girls. Menstruation during puberty is often irregular; however, excessively heavy bleeding requires close attention from parents and doctors [2]. Understanding the potential causes helps to timely identify hidden pathologies and prevent complications such as anemia.
How to Recognize Pathological Blood Loss?
Adolescents cannot always objectively assess the volume of discharge. There are certain clinical criteria of the menstrual history that indicate the presence of hidden blood clotting disorders or other pathologies [2]:
- menstrual duration of more than 7 days [2];
- the need to change more than 5 sanitary products a day or change them during the night [2];
- passage of large blood clots [2];
- lack of effect from standard therapy [2].
If such symptoms are present, in-depth diagnostics is necessary, as they may signal systemic malfunctions in the body.
Hereditary Blood Clotting Disorders
One of the important tasks for a hematologist when examining girls with heavy menstrual bleeding is to search for hidden coagulopathies [2]. In particular, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is the second most common hereditary vascular disorder, in which heavy menstrual bleeding occurs in 35% of women of reproductive age [4]. A detailed personal and family history helps to suspect such disorders in time [2].
Iron Deficiency and Anemia
Constant loss of a large volume of blood inevitably leads to the depletion of iron stores in the body. Iron deficiency states (both with and without the development of anemia) are extremely frequently recorded in young girls with heavy menstrual bleeding [2]. That is why during the initial examination, doctors prescribe not only a complete blood count, but also an assessment of iron metabolism indicators in order to timely correct the deficiency [2].
The Role of the Endocrine System: Are Heavy Periods Related to the Thyroid Gland?
Many patients and parents worry that heavy menstruation is caused by thyroid pathology. However, studies show that the frequency of actual thyroid diseases among adolescents with this complaint is extremely low (about 0.23%), which is even lower than the rates in the general population [1]. Consequently, targeted hormonal testing of the thyroid gland is advisable to carry out only in the presence of concomitant clinical symptoms of endocrine disorders [1].
Conclusion and Recommendations
Heavy periods in adolescents are not just a variant of the transitional age norm, but a condition requiring an integrated approach. A timely examination by a pediatrician, gynecologist, or hematologist allows excluding hemostasis disorders [2], assessing iron levels [2], and prescribing the correct treatment, returning the girl to good well-being and health.
References
- [1] Incidence of Thyroid Disease in Adolescent Females Presenting with Heavy Menstrual Bleeding. PubMed
- [2] Evaluation and management of heavy menstrual bleeding in adolescents: the role of the hematologist. PubMed
- [3] Retroperitoneal Extra-Adrenal Paraganglioma Presenting With Secondary Amenorrhea and Hypertension in an Adolescent: A Rare Case From Sub-Saharan Africa. PubMed
- [4] Clinical spectrum of hereditary hemorrhagic telangiectasia: data from the Comprehensive HHT Outcomes Registry of the US (CHORUS). PubMed
- [5] Double myocardial bridge causing acute myocardial infarction in a premenopausal woman. PubMed
- [6] The Hidden Crisis: A Rare Case of Thyrotoxicosis in a Young Female, Mimicking Neuromuscular Disease. PubMed
- [7] Incomplete Brown-Séquard syndrome secondary to acenocoumarol-induced hematomyelia: A case report. PubMed
- [8] Factors influencing re-bleeding after trans-arterial embolization for endoscopically unmanageable peptic ulcer bleeding. PubMed
Disclaimer: The information presented in this article is for informational purposes only and does not replace an in-person consultation with a medical specialist.