Bleeding disorders in adolescence
Bleeding disorders in adolescence mostly occur when ovulation does not take place during the menstrual cycle. This is called an anovulatory cycle. This can occur more frequently in adolescence because the hypothalamic-pituitary axis (a regulatory pathway of the central nervous system) is not yet fully matured.
Anovulatory cycles in adolescents are mainly characterized by irregular and heavy menstrual bleeding. The bleeding intervals are often prolonged (> 45 days).
In addition to anovulatory cycles, there are also other or rarer reasons for cycle disorders. These include coagulation disorders such as von Willebrand factor deficiency, platelet function disorders, etc., which can lead to increased menstrual bleeding. In addition to heavy menstrual bleeding, other symptoms such as nosebleeds, bruising or bleeding in the gastrointestinal tract are often present.
Primary amenorrhea (= absence of menstruation) may be a sign of a genital malformation or ovarian insufficiency.
Secondary amenorrhea (= absence of menstruation after a menstrual cycle has already occurred) can have various causes. In adolescents, this is often caused by stress, weight loss, excessive exercise or eating disorders. Less common causes of secondary amenorrhea in adolescence can include polycystic ovary syndrome, thyroid disease, certain medications, pregnancy, etc.
Sexually transmitted diseases such as chlamydia can also cause bleeding disorders such as intermenstrual bleeding or bleeding after sexual intercourse.
What is normal?
A normal menstrual period in adolescents does not last longer than 7 days and occurs every 21- 45 days. Blood loss is usually 30-80 ml per cycle, which corresponds to approx. 3-6 tampons/pads per day.
The onset of menstruation is considered normal up to the age of 15. On average, the onset of menstruation is at 12.4 years.
When should a gynecological consultation take place?
In the case of prolonged bleeding, excessively heavy bleeding, absence of menstruation (> 90 days) or severe menstrual pain, an adolescent gynecological consultation should be sought for advice. In a detailed conversation, the various therapy options are then discussed.
Sometimes an ultrasound is also necessary. In patients who are not yet sexually active, this is performed via the abdomen with a full bladder.
Therapy options
For pain during menstruation, measures such as heat therapy, relaxation techniques or taking chasteberry can be tried first. However, it is often necessary to cover with painkillers according to an individual (weight-adapted) scheme. The aim is to avoid pain peaks and to start with the painkillers before/at the onset of pain. As painkillers, nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen are the most effective.
If the pain persists, hormonal therapy with a birth control pill can also be an effective therapeutic approach.
Hormonal therapy is also often necessary for bleeding disorders, and in the case of excessively heavy bleeding, antifibrinolytics such as tranexamic acid can also be used. Chasteberry can also help regulate the cycle.
In the case of heavy blood loss during the period, the iron level should also be checked. Iron deficiency should be treated.
We would be happy to offer you individual advice in our adolescent gynecology consultation.
Anna Fischer
