https://doi.org/10.4081/btvb.2024.106
Diagnosis and management of abnormal uterine bleeding in adolescence
An expert Consensus Statement of SIGO (Italian Society of Gynecology and Obstetrics) and SISET (Italian Society for the Study of Hemostasis and Thrombosis)
Submitted: 28 December 2023
Accepted: 22 April 2024
Published: 8 May 2024
Accepted: 22 April 2024
Abstract Views: 329
PDF: 132
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
During menarche and adolescence, abnormal uterine bleeding (AUB) may serve as a crucial indicator of a hidden bleeding disorder. When a young woman is suspected of having a bleeding disorder, the obstetrician-gynecologist should collaborate with a hemostasis specialist to arrange the necessary laboratory testing and determine the best course of action. The Italian Society for the Study of Hemostasis and Thrombosis and the Italian Society of Gynecology and Obstetrics jointly offer recommendations on the diagnosis and treatment of AUB. They also suggest diagnostic and therapeutic pathways to decrease diagnostic delay and improve treatment effectiveness and safety.
Moon LM, Perez-Milicua G, Dietrich JE. Evaluation and management of heavy menstrual bleeding in adolescents. Curr Opin Obstet Gynecol 2017;29:328336.
DOI: https://doi.org/10.1097/GCO.0000000000000394
National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management. 2021. Available from: http://www.ncbi.nlm.nih.gov/books/NBK493300/ (accessed on October 27, 2022)
Pawar A, Krishnan R, Davis K, et al. Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescent with bleeding disorders. Haemophilia 2008;14:579-83.
DOI: https://doi.org/10.1111/j.1365-2516.2008.01652.x
Miller CH, Philipp CS, Stein SF, et al. The spectrum of haemostatic characteristics of women with unexplained menorrhagia: haemostatic characteristics in menorrhagia. Haemophilia 2011;17:e223-e229.
DOI: https://doi.org/10.1111/j.1365-2516.2010.02382.x
Gresele P, Orsini S, Noris P, et al. Validation of the ISTH/SSC bleeding assessment tool for inherited platelet disorders: a communication from the Platelet Physiology SSC. J Thromb Haemost 2020;18:73239.
DOI: https://doi.org/10.1111/jth.14683
Ramalho I, Leite H, Águas F. Abnormal uterine bleeding in adolescents: a multidisciplinary approach. Acta Med Port 2021;34:291-7.
DOI: https://doi.org/10.20344/amp.12829
ACOG. Committee Opinion N. 785: Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG. Obstet Gynecol 2019;134:e71-e83.
DOI: https://doi.org/10.1097/AOG.0000000000003411
Alaqzam TS, Stanley AC, Simpson PM, et al. Treatment modalities in adolescents who present with heavy menstrual bleeding. J Pediatr Adolesc Gynecol 2018;31:451-8.
DOI: https://doi.org/10.1016/j.jpag.2018.02.130
Benjamins LJ. Practice guideline: evaluation and management of abnormal vaginal bleeding in adolescents. J Pediatr Health Care 2009;23:189-93.
DOI: https://doi.org/10.1016/j.pedhc.2009.02.003
Bofill Rodriguez M, Lethaby A, Low C, Cameron IT. Cyclical progestogens for heavy menstrual bleeding. Cochrane Gynaecology and Fertility Group (eds.). Cochrane Database Syst Rev 2019.
DOI: https://doi.org/10.1002/14651858.CD001016.pub3
Bofill Rodriguez M, Dias S, Jordan V, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Gynaecology and Fertility Group (eds.). Cochrane Database Syst Rev 2022;2022.
DOI: https://doi.org/10.1002/14651858.CD013180.pub2
Fraser IS, Parked S, Mellinger U, et al. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 2011;16:258-69.
DOI: https://doi.org/10.3109/13625187.2011.591456
Borzutzky C, Jaffray J. Diagnosis and management of heavy menstrual bleeding and bleeding disorders in adolescents. JAMA Pediatr 2020;174:186.
DOI: https://doi.org/10.1001/jamapediatrics.2019.5040
Bryant-Smith AC, Lethaby A, Farquhar C. Antifibrinolytics for heavy menstrual bleeding. Cochrane Gynaecology and Fertility Group (eds.). Cochrane Database Syst Rev 2018;2018.
DOI: https://doi.org/10.1002/14651858.CD000249.pub2
Chi C, Pollard D, Tuddenham EGD, Kadir RA. Menorrhagia in adolescents with inherited bleeding disorders. J Pediatr Adolesc Gynecol 2010;23:215-22.
DOI: https://doi.org/10.1016/j.jpag.2009.11.008
Kouides PA, Byams VR, Philipp CS, et al. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. Br J Haematol 2009;145:212-20.
Amesse L, Pfaff-Amesse T, Leonardi R, et al. Oral contraceptives and DDAVP nasal spray: patterns of use in managing VWD-associated menorrhagia: a single-institution study. J Pediatr Hematol Oncol 2005;27:357-63.
DOI: https://doi.org/10.1097/01.mph.0000173175.95152.95
Connell NT, Flood VH, Brignardello-Petersen R, et al. ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease. Blood Adv 2021;5:301-25.
DOI: https://doi.org/10.1182/bloodadvances.2020003264
Haamid F, Sass AE, Dietrich JE. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol 2017;30:335-4.
DOI: https://doi.org/10.1016/j.jpag.2017.01.002
Warad D, Chirlur M, Philipp C. Platelet disorders in the adolescent female. In: Hematology in the Adolecent Female. Srivaths LV (ed.). Springer; 2020.
DOI: https://doi.org/10.1007/978-3-030-48446-0_6
Kouides PA, Byams VR, Philipp CS, et al. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. Br J Haematol 2009;145:212-20.
DOI: https://doi.org/10.1111/j.1365-2141.2009.07610.x
Gleeson N, Buggy F, Sheppard BL, Bonnar J. The effect of tranexamic acid on measured menstrual loss and endometrial fibrinolytic enzymes in dysfunctional uterine bleeding. Acta Obstet Gynecol Scand 1994;73:274-7.
DOI: https://doi.org/10.3109/00016349409023453
Desborough MJR, Oakland KA, Landoni G, et al. Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta-analysis of randomized controlled trials. J Thromb Haemost 2017;15:263-72.
DOI: https://doi.org/10.1111/jth.13576
Bolton-Maggs PHB, Perry DJ, Chalmers EA, et al. The rare coagulation disorder review with guidelines for management from the United Kingdom Haemophilia Centre Doctors’ Organisation. Haemophilia 2004;10:593-628.
DOI: https://doi.org/10.1111/j.1365-2516.2004.00944.x
ACOG. Committee Opinion N. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol 2013;121:891-6.
DOI: https://doi.org/10.1097/01.AOG.0000428646.67925.9a
Gresele P, Falcinelli E, Bury L. Inherited platelet disorders in women. Thromb Res 2019;181:S54-S59.
DOI: https://doi.org/10.1016/S0049-3848(19)30368-8
Avni T, Bieber A, Grossman A, et al. The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clin Proc 2015;90:12-23.
DOI: https://doi.org/10.1016/j.mayocp.2014.10.007
How to Cite
Santi, R. M., Fulghesu, A., Zanon, E., De Candia, E., Grandone, E., Di Renzo, G., … Gresele, P. (2024). Diagnosis and management of abnormal uterine bleeding in adolescence: An expert Consensus Statement of SIGO (Italian Society of Gynecology and Obstetrics) and SISET (Italian Society for the Study of Hemostasis and Thrombosis). Bleeding, Thrombosis and Vascular Biology, 3(1). https://doi.org/10.4081/btvb.2024.106
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Most read articles by the same author(s)
- Samantha Pasca, Cristina Santoro, Chiara Ambaglio, Marisanta Napolitano, Marta Milan, Letizia Natali, Silvia Nannizzi, Filippo Mori, Paolo Simioni, Ezio Zanon, Comparison among three different bleeding scores and the thrombin generation assay to assess the different hemorrhagic phenotypes in patients with FVII deficiency , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Stefania Momi, Giuseppe Guglielmini, Giulia Ciarroca Taranta, Elisa Giglio, Angela Monopoli, Paolo Gresele, A nitric oxide-donor pravastatin hybrid drug exerts antiplatelet and antiatherogenic activity in mice , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Daniela Poli, Emilia Antonucci, Gualtiero Palareti, Roberto Facchinetti, Pietro Falco, Giuseppina Serricchio, Teresa Lerede, Lucilla Masciocco, Paolo Gresele, Sophie Testa, Major bleedings in mechanical prosthetic heart valves patients on Vitamin K antagonist treatment. Data from the PLECTRUM Study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Giovanni Tiscia, Elvira Grandone, Talking about assisted reproductive techniques and thromboembolic risk: everything we always wanted to know , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Loredana Bury, Paolo Gresele, The amazing genetic complexity of anucleated platelets , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Paolo Gresele, Artificial intelligence and machine learning in hemostasis and thrombosis , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 4 (2023)
- Francesco Marongiu, Elvira Grandone, Silvia Marongiu, Antonella Mameli, Doris Barcellona, Stroke in women: anticoagulation in a complicated puzzle , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 2 (2024)
- Stefania Momi, Paolo Gresele, Blood platelets and Charles Darwin’s natural selection , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
- Daniela Poli, Riccardo Tartaglia, Doris Barcellona , Paolo Bucciarelli , Antonio Ciampa, Elvira Grandone, Giuseppe Malcangi, Giuseppe Rescigno, Vincenzo Toschi, Sophie Testa, Alessandro Squizzato, Attitude to clinical research among health professionals affiliated with the Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (FCSA) , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
