A retrospective comparison of time to cessation of acute heavy menstrual bleeding in adolescents following two dose regimens of combined oral hormonal therapy.

Abstract Study Objective : While multiple hormonal treatment strategies are effective in decreasing heavy menstrual bleeding (HMB) in adolescents, few studies compare relative effectiveness of hormone therapy based on dose. Design : Retrospective chart review Setting : Urban tertiary care institution Participants : Adolescents aged 9-19 years with acute HMB and anemia in 2008-2018 Interventions : We used billing codes to identify encounters for acute HMB with hemoglobin 35mcg/day in any step-down regimen). Main Outcome Measures : Time until patient-reported resolution of acute HMB, measured in days from initial treatment. Results : Of 207 patients with vaginal bleeding and anemia, 90 met criteria for review of therapy type and dose. Users of combined EE/P were hormone-naive in 28/33 (84.8%) of those who initiated standard EE/P and 22/32 (68.8%) who initiated taper dosing. Bleeding duration was available for 15/28 (53.6%) and 18/22 (81.8%). Resolution of HMB occurred in 0-9 days with standard dosing (mean ±SD 2.1±2.3 days) versus 1-15 days for taper dosing (4.9±4.7; p=0.04). Excluding six outliers of zero or >10 days, HMB ceased by 2.6 and 3 days (n=12 and 15; p=0.62). Conclusions : Currently recommended higher dose combined hormonal regimens do not appear to shorten the time to resolution of acute heavy menstrual bleeding in adolescents.