Consensus Papers
Vol. 3 No. 1 (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)
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.
Received: 28 December 2023
Accepted: 22 April 2024
Accepted: 22 April 2024
1040
Views
414
Downloads
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.
Downloads
Download data is not yet available.
Citations
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
1.
Santi RM, Fulghesu A, Zanon E, De Candia E, Grandone E, Di Renzo G, et al. 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 Thromb Vascul Biol [Internet]. 2024 May 8 [cited 2025 Sep. 18];3(1). Available from: https://www.btvb.org/btvb/article/view/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.
Similar Articles
- Marcello Di Nisio, Matteo Candeloro, Nicola Potere, Ettore Porreca, Jeffrey I. Weitz, Factor XI inhibitors: a new option for the prevention and treatment of cancer-associated thrombosis , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. s1 (2024)
- Giovanni de Gaetano, Welcome to AICE and sincere wishes for peace for the new year 2024 , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 4 (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)
- Anna Falanga, Hugo Ten Cate, Bianca Rocca, How to manage antithrombotic treatments in thrombocytopenic patients with cancer. Comments on the European Haematology Association guidelines , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
- Giovanni de Gaetano, Science in Ukraine is “bleeding” , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
- Giancarlo Castaman, Gene transfer in hemophilia B: a big step forward , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 2 (2023)
- Mosaad Almegren, Clinical and radiological characteristics of cerebral vein thrombosis: a retrospective study , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Vittorio Pengo, Luca Sarti, Emilia Antonucci, Stefania Di Agostino, Elisa Bison, Gentian Denas, Daniela Poli, Pier Luigi Meroni, Roberto Gerli, Antonella Radice, Gualtiero Palareti, on behalf of FIRMA group and START collaborators, Descriptive analysis of patients positive for anti-phospholipid antibodies included in two Italian registries , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Paolo Prandoni, Personalized bleeding risk assessment for atrial fibrillation patients on direct oral anticoagulants: the DOAC score , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Ilaria Nichele, Giuseppe Carli, Alberto Tosetto, Tailored therapy with turoctocog alfa pegol according to patient’s lifestyle and hemorrhagic phenotype: from clinical trial to real-life , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 1 (2024)
You may also start an advanced similarity search for this article.
