{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:34:55Z","timestamp":1792172095054,"version":"4.4.0"},"reference-count":75,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,11,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Heavy menstrual bleeding (HMB) is frequently reported by adolescents. The role of the hematologist is threefold in evaluating such patients: (1) perform a clinical and laboratory evaluation for an underlying bleeding disorder on the basis of the degree of clinical suspicion, (2) identify and manage any concomitant iron deficiency, and (3) provide input to the referring provider regarding the management of HMB, particularly for patients with identified hemostatic defects. Several clues in the menstrual history should raise suspicion for an underlying bleeding disorder, such as menses lasting &gt;7 days, menstrual flow which soaks &gt;5 sanitary products per day or requires product change during the night, passage of large blood clots, or failure to respond to conventional therapies. A detailed personal and family history of other bleeding symptoms should also be obtained. Iron deficiency with and without anemia is commonly found in young women with HMB. Therefore, it is important to obtain measures of hemoglobin and ferritin levels when evaluating these patients. Iron supplementation is often a key component of management in the adolescent with heavy menses and is still needed in those who have received packed red cell transfusions as a result of severe anemia. Strategies for decreasing menstrual blood flow are similar for adults and adolescents with heavy menses, with combined hormonal contraceptives recommended as first-line therapy. However, there are adolescent-specific considerations for many of these agents, and they must be incorporated into shared decision-making when selecting the most appropriate treatment.<\/jats:p>","DOI":"10.1182\/asheducation-2018.1.390","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T22:13:59Z","timestamp":1555452839000},"page":"390-398","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":27,"title":["Evaluation and management of heavy menstrual bleeding in adolescents: the role of the hematologist"],"prefix":"10.1182","volume":"2018","author":[{"given":"Sarah H.","family":"O\u2019Brien","sequence":"first","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology, Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, OH; and"},{"name":"Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children\u2019s Hospital, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"2","key":"2019111522324624700_B1","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":"Friberg","year":"2006","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"6","key":"2019111522324624700_B2","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1097\/AOG.0000000000002620","article-title":"Patterns of von Willebrand disease screening in girls and adolescents with heavy menstrual bleeding","volume":"131","author":"Jacobson","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"3","key":"2019111522324624700_B3","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1111\/j.1365-2516.2008.01652.x","article-title":"Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders","volume":"14","author":"Pawar","year":"2008","journal-title":"Haemophilia"},{"issue":"1","key":"2019111522324624700_B4","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1365-2516.2007.01586.x","article-title":"Review of quality of life: menorrhagia in women with or without inherited bleeding disorders","volume":"14","author":"Shankar","year":"2008","journal-title":"Haemophilia"},{"issue":"5","key":"2019111522324624700_B5","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\u2019s Hospitals","volume":"31","author":"Powers","year":"2018","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"1","key":"2019111522324624700_B6","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/AOG.0b013e318262e320","article-title":"Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women","volume":"120","author":"Committee on Practice Bulletins\u2014Gynecology","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"4","key":"2019111522324624700_B7","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.ajog.2012.01.046","article-title":"The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them?","volume":"207","author":"Munro","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"2019111522324624700_B8","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":"Haamid","year":"2017","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"2019111522324624700_B9","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":"Zia","year":"2016","journal-title":"Thromb Res"},{"issue":"1","key":"2019111522324624700_B10","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/j.1538-7836.2010.04105.x","article-title":"Impact of sex, age, race, ethnicity and aspirin use on bleeding symptoms in healthy adults","volume":"9","author":"Mauer","year":"2011","journal-title":"J Thromb Haemost"},{"key":"2019111522324624700_B11","unstructured":"National Hemophilia Foundation. 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