{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:33:46Z","timestamp":1784010826274,"version":"3.55.0"},"reference-count":51,"publisher":"Georg Thieme Verlag KG","issue":"01\/02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Reprod Med"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Heavy, and often irregular, menstrual bleeding (HMB) is a common gynecologic complaint among adolescents. During the first few post-menarcheal years, anovulatory cycles related to immaturity of the hypothalamic\u2013pituitary\u2013ovarian axis are the most common etiology for abnormal uterine bleeding and should be considered as a part of normal pubertal development rather than a disease. If an already regular menstrual cycle becomes irregular, secondary causes of anovulation should be ruled out. Inherited and acquired bleeding disorders, such as von Willebrand disease, and quantitative and qualitative abnormalities of platelets are relatively common findings in adolescents with HMB from menarche. History of excessive bleeding or a diagnosed bleeding disorder in the family supports this etiology, warranting specialized laboratory testing. First-line treatment of HMB among adolescents is medical management with hormonal therapy or nonhormonal options. Levonorgestrel-releasing intrauterine device is an effective tool also for all adolescents with menstrual needs.<\/jats:p>","DOI":"10.1055\/s-0041-1739309","type":"journal-article","created":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T00:05:22Z","timestamp":1635984322000},"page":"023-031","source":"Crossref","is-referenced-by-count":8,"title":["Heavy Menstrual Bleeding in Adolescent: Normal or a Sign of an Underlying Disease?"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-2891","authenticated-orcid":false,"given":"Kaisu","family":"Luiro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3572-1337","authenticated-orcid":false,"given":"Elina","family":"Holopainen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,11,3]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/ijgo.12666","article-title":"The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions","volume":"143","author":"M G Munro","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"e143","DOI":"10.1097\/AOG.0000000000001215","article-title":"ACOG Committee Opinion No. 651: menstruation in girls and adolescents: using the menstrual cycle as a vital sign","volume":"126","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1080\/00016340500342912","article-title":"Bleeding disorders among young women: a population-based prevalence study","volume":"85","author":"B Friberg","year":"2006","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.jpag.2018.06.008","article-title":"Hematologic considerations and management of adolescent girls with heavy menstrual bleeding and anemia in US children's hospitals","volume":"31","author":"J M Powers","year":"2018","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/hae.12046","article-title":"Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding","volume":"19","author":"W Wang","year":"2013","journal-title":"Haemophilia"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.thromres.2016.05.001","article-title":"Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding","volume":"143","author":"A Zia","year":"2016","journal-title":"Thromb Res"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1210\/er.2018-00116","article-title":"Clinical management of congenital hypogonadotropic hypogonadism","volume":"40","author":"J Young","year":"2019","journal-title":"Endocr Rev"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.fertnstert.2020.06.038","article-title":"Role of kisspeptins in the control of the hypothalamic-pituitary-ovarian axis: old dogmas and new challenges","volume":"114","author":"S T Ruohonen","year":"2020","journal-title":"Fertil Steril"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1159\/000336325","article-title":"Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty","volume":"77","author":"K S\u00f8rensen","year":"2012","journal-title":"Horm Res Paediatr"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"e932","DOI":"10.1542\/peds.2008-2491","article-title":"Recent decline in age at breast development: the Copenhagen Puberty Study","volume":"123","author":"L Aksglaede","year":"2009","journal-title":"Pediatrics"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1542\/peds.111.1.110","article-title":"Age at menarche and racial comparisons in US girls","volume":"111","author":"W C Chumlea","year":"2003","journal-title":"Pediatrics"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/0022-4731(84)90209-7","article-title":"Endocrine characteristics of adolescent menstrual cycles: impact of early menarche","volume":"20","author":"R Vihko","year":"1984","journal-title":"J Steroid Biochem"},{"issue":"09","key":"ref14","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1111\/j.1538-7836.2010.03975.x","article-title":"ISTH\/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders","volume":"8","author":"F Rodeghiero","year":"2010","journal-title":"J Thromb Haemost"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/hae.12503","article-title":"Normal range of bleeding scores for the ISTH-BAT: adult and pediatric data from the merging project","volume":"20","author":"M Elbatarny","year":"2014","journal-title":"Haemophilia"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1182\/asheducation-2018.1.390","article-title":"Evaluation and management of heavy menstrual bleeding in adolescents: the role of the hematologist","volume":"2018","author":"S H O'Brien","year":"2018","journal-title":"Hematology (Am Soc Hematol Educ Program)"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ogc.2008.12.002","article-title":"Bleeding disorders in adolescents","volume":"36","author":"A H James","year":"2009","journal-title":"Obstet Gynecol Clin North Am"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jpag.2018.02.130","article-title":"Treatment modalities in adolescents who present with heavy menstrual bleeding","volume":"31","author":"T S Alaqzam","year":"2018","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1080\/03014468400007411","article-title":"Menstrual patterns in adolescent Swiss girls: a longitudinal study","volume":"11","author":"D Flug","year":"1984","journal-title":"Ann Hum Biol"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"240","DOI":"10.5935\/1518-0557.20160046","article-title":"Obesity and anovulatory infertility: a review","volume":"20","author":"C R Giviziez","year":"2016","journal-title":"JBRA Assist Reprod"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/S0140-6736(97)08248-2","article-title":"Frequency of inherited bleeding disorders in women with menorrhagia","volume":"351","author":"R A Kadir","year":"1998","journal-title":"Lancet"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/hae.12012","article-title":"Menstrual bleeding patterns and prevalence of bleeding disorders in a multidisciplinary adolescent haematology clinic","volume":"19","author":"K T Vo","year":"2013","journal-title":"Haemophilia"},{"issue":"S 05","key":"ref23","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/j.1365-2516.2010.02315.x","article-title":"Women and bleeding disorders","volume":"16","author":"A H James","year":"2010","journal-title":"Haemophilia"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1365-2516.2005.01108.x","article-title":"More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders","volume":"11","author":"A H James","year":"2005","journal-title":"Haemophilia"},{"issue":"13","key":"ref25","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1182\/blood-2014-08-532820","article-title":"Rare bleeding disorders: diagnosis and treatment","volume":"125","author":"R Palla","year":"2015","journal-title":"Blood"},{"issue":"23","key":"ref26","doi-asserted-by":"crossref","first-page":"3829","DOI":"10.1182\/bloodadvances.2019000966","article-title":"American Society of Hematology 2019 guidelines for immune thrombocytopenia","volume":"3","author":"C Neunert","year":"2019","journal-title":"Blood Adv"},{"issue":"04","key":"ref27","first-page":"630","article-title":"von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia","volume":"97","author":"A Dilley","year":"2001","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"e223","DOI":"10.1111\/j.1365-2516.2010.02382.x","article-title":"The spectrum of haemostatic characteristics of women with unexplained menorrhagia","volume":"17","author":"C H Miller","year":"2011","journal-title":"Haemophilia"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1111\/hae.12293","article-title":"Platelet function defects in adolescents with heavy menstrual bleeding","volume":"20","author":"H L Mills","year":"2014","journal-title":"Haemophilia"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1001\/jamapediatrics.2019.5040","article-title":"Diagnosis and management of heavy menstrual bleeding and bleeding disorders in adolescents","volume":"174","author":"C Borzutzky","year":"2020","journal-title":"JAMA Pediatr"},{"issue":"09","key":"ref31","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/humrep\/dey256","article-title":"Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"33","author":"H J Teede","year":"2018","journal-title":"Hum Reprod"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/AOG.0000000000003693","article-title":"Abnormal uterine bleeding in the adolescent","volume":"135","author":"A Hernandez","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"e27675","DOI":"10.1002\/pbc.27675","article-title":"Characterizing adolescents with heavy menstrual bleeding and generalized joint hypermobility","volume":"66","author":"N E Kendel","year":"2019","journal-title":"Pediatr Blood Cancer"},{"issue":"05","key":"ref34","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1055\/s-2006-947861","article-title":"Aspects of the laboratory identification of von Willebrand disease in women","volume":"32","author":"P A Kouides","year":"2006","journal-title":"Semin Thromb Hemost"},{"issue":"06","key":"ref35","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jpag.2016.05.009","article-title":"Iron deficiency without anemia: a common yet under-recognized diagnosis in young women with heavy menstrual bleeding","volume":"29","author":"S Johnson","year":"2016","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"02","key":"ref36","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1586\/17474086.2016.1126177","article-title":"Common gynecological challenges in adolescents with sickle cell disease","volume":"9","author":"S J Stimpson","year":"2016","journal-title":"Expert Rev Hematol"},{"issue":"S 01","key":"ref37","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/ijlh.12345","article-title":"Laboratory diagnosis of von Willebrand disease","volume":"37","author":"J C Roberts","year":"2015","journal-title":"Int J Lab Hematol"},{"issue":"04","key":"ref38","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1002\/ajh.25393","article-title":"Automated assays for von Willebrand factor activity","volume":"94","author":"R A Higgins","year":"2019","journal-title":"Am J Hematol"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jpag.2011.10.010","article-title":"Can von Willebrand disease be investigated on combined hormonal contraceptives?","volume":"26","author":"T Dumont","year":"2013","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"11","key":"ref40","doi-asserted-by":"crossref","first-page":"e524","DOI":"10.1016\/S2352-3026(17)30182-5","article-title":"Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials","volume":"4","author":"N U Stoffel","year":"2017","journal-title":"Lancet Haematol"},{"issue":"01","key":"ref41","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1097\/AOG.0000000000004209","article-title":"Options for prevention and management of menstrual bleeding in adolescent patients undergoing cancer treatment: ACOG Committee Opinion, Number 817","volume":"137","author":"American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care","year":"2021","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref42","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/AOG.0000000000001581","article-title":"Committee Opinion No. 668 Summary: menstrual manipulation for adolescents with physical and developmental disabilities","volume":"128","year":"2016","journal-title":"Obstet Gynecol"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/AOG.0000000000000387","article-title":"Menstrual and reproductive issues in adolescents with physical and developmental disabilities","volume":"124","author":"E H Quint","year":"2014","journal-title":"Obstet Gynecol"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/j.jpag.2019.04.007","article-title":"Hormonal contraceptives, intrauterine devices, gonadotropin-releasing hormone analogues and testosterone: menstrual suppression in special adolescent populations","volume":"32","author":"S Pradhan","year":"2019","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"315","DOI":"10.2147\/IJWH.S102306","article-title":"Transdermal delivery of combined hormonal contraception: a review of the current literature","volume":"9","author":"R M Galzote","year":"2017","journal-title":"Int J Womens Health"},{"key":"ref47","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.seizure.2015.03.006","article-title":"Interactions between hormonal contraception and antiepileptic drugs: clinical and mechanistic considerations","volume":"28","author":"A Reimers","year":"2015","journal-title":"Seizure"},{"issue":"08","key":"ref48","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1038\/sj.bmt.1701187","article-title":"Luteinizing hormone-releasing hormone analogue: leuprorelin acetate for the prevention of menstrual bleeding in premenopausal women undergoing stem cell transplantation","volume":"21","author":"P Chiusolo","year":"1998","journal-title":"Bone Marrow Transplant"},{"issue":"03","key":"ref49","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jpag.2017.01.002","article-title":"Heavy menstrual bleeding in adolescents","volume":"30","author":"F Haamid","year":"2017","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"05","key":"ref50","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/GCO.0b013e3283562bcb","article-title":"Management of heavy menstrual bleeding in adolescents","volume":"24","author":"N Sokkary","year":"2012","journal-title":"Curr Opin Obstet Gynecol"},{"issue":"04","key":"ref51","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1097\/01.AOG.0000428646.67925.9a","article-title":"ACOG Committee Opinion No. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women","volume":"121","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref52","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1365-2516.2007.01643.x","article-title":"von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA)","volume":"14","author":"W L Nichols","year":"2008","journal-title":"Haemophilia"},{"issue":"02","key":"ref53","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/bmjsrh-2020-200619","article-title":"Norethisterone and its acetate - what's so special about them?","volume":"47","author":"E Huvinen","year":"2021","journal-title":"BMJ Sex Reprod Health"}],"container-title":["Seminars in Reproductive Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1739309.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T23:35:38Z","timestamp":1656632138000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1739309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,3]]},"references-count":51,"journal-issue":{"issue":"01\/02","published-online":{"date-parts":[[2022,6,30]]},"published-print":{"date-parts":[[2022,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1739309","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1526-8004","1526-4564"],"issn-type":[{"value":"1526-8004","type":"print"},{"value":"1526-4564","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,3]]}}}