Volume 26, Issue 2 p. 84-94
Review

Heavy menstrual bleeding in adolescence: who to investigate and how to manage it

S L Walter MBChB(hons) MRCOG

Corresponding Author

S L Walter MBChB(hons) MRCOG

Speciality Registrar in Obstetrics and Gynaecology, Severn Deanery, UK

Correspondence: S L Walter. Email: [email protected]

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S Channing MBBS MA(Cantab) MRCOG PGCertMedEd

S Channing MBBS MA(Cantab) MRCOG PGCertMedEd

Consultant Gynaecologist with a special interest in Paediatric & Adolescent Gynaecology, University Hospitals Bristol and Weston NHS Foundation Trust, St Michaels Hospital, Southwell Street, Bristol, BS2 8EG UK

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N S Crouch MD MRCOG

N S Crouch MD MRCOG

Consultant Gynaecologist with a special interest in Paediatric & Adolescent Gynaecology, University Hospitals Bristol and Weston NHS Foundation Trust, St Michaels Hospital, Southwell Street, Bristol, BS2 8EG UK

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First published: 01 April 2024

Abstract

Key content

  • Adolescent heavy menstrual bleeding (HMB) is commonly related to hypothalamic pituitary ovarian axis immaturity, which improves with age. This article outlines when and how to investigate for underlying pathological causes.
  • Medical treatment for adolescent HMB consists predominantly of hormonal contraceptives. Preparation choice depends upon patient preference, comorbidities and co-existing conditions.
  • Acute adolescent HMB is rare; a suggested framework for assessing and managing such cases is provided within this article.

Learning objectives

  • To understand how to clinically evaluate adolescent HMB.
  • To understand when and how to investigate adolescent HMB.
  • To understand the different medical treatment options for HMB, their efficacy, risks and alternatives.
  • To understand the management of acute adolescent HMB.

Ethical issues

  • Duties of confidentiality must be balanced against safeguarding concerns.