Evaluation of the Adolescent with Heavy Menstrual Bleeding

Bleeding disorders constitute an important etiology of heavy menstrual bleeding in adolescents that require thoughtful planning of the laboratory evaluation. Optimal diagnostic strategies should consider the pretest probability of a bleeding problem based on the patient’s personal and family history of bleeding and should always follow a bleeding history. Physicians, including adolescent medicine, family practice, and obstetrician-gynecologists, should work in coordination with a hematologist for management of heavy menstrual bleeding, including diagnostic evaluation of a bleeding disorder. Such evaluation in adolescent girls should include assessment of anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and testing for an underlying bleeding disorder. The highest yield initial tests for diagnosing a bleeding disorder in adolescents with heavy menstrual bleeding include von Willebrand panel and platelet function testing. This chapter will summarize the laboratory evaluation of bleeding disorders in adolescents with heavy periods with an emphasis on practical considerations.