Management of acute adolescent menorrhagia

OBJECTIVE: The aim of this study is to determine the most effective medical management of acute adolescent menorrhagia. STUDY METHODS: Retrospective chart review taking place at Sainte-Justine Hospital between October 1989 and December 1999. All adolescents admitted with menorrhagia as the primary diagnosis, with hemoglobin < 100 gm/L were reviewed. Adolescents with genital tract pathology and pregnancy were excluded. The details of interest included: etiology of the menorrhagia; personal or family history of bleeding diathesis; hemoglobin and coagulation profiles on admission; type and response to various medical treatments; the necessity for surgical intervention. RESULTS: 31 adolescents (mean age of 14.4 years) were identified. The mean hemoglobin on admission was 65.2 g/L. Coagulation profiles, bleeding time and von Willebrand's testing were done in 100% (31/31), 45.1% (14/31) and 37.9% (11/29) of patients, respectively. 87.1% (27/31) of patients were found to have anovulatory uterine bleeding (AUB) as a diagnosis of exclusion, while 9.7% (3/31) of patients were found to have a primary hematologic disorder. All 31 patients were treated with supportive measures and high dose estrogen therapy (Premarin®, Wyeth-Ayerst). In addition, 12.9% (4/31) patients received antifibrinolytic therapy (Amicar ®, Wyeth-Ayerst). 45% (14/31) of patients required blood transfusions, of which 11 patients had AUB and 3 patients had a hematologic disorder. Complete cessation of bleeding with medical treatment was achieved in 87.1% (27/31) of patients. 12.9% (4/31) of patients required a dilatation and curretage for ongoing bleeding, with an excellent response. However, 2 of these patients had received suboptimal estrogen therapy. CONCLUSIONS: In addition to the usual supportive treatment, adolescents admitted with acute, severe menorrhagia should continue to be treated medically using high dose estrogen therapy. Consideration should be given to adding an antifibrinolytic therapy in an effort to reduce the need for blood transfusions and surgical interventions.