Advertisement

Underdiagnosed Menorrhagia in Adolescents is Associated with Underdiagnosed Anemia

Published:September 20, 2011DOI:https://doi.org/10.1016/j.jpeds.2011.08.014

      Objective

      To test the hypothesis that adolescent girls with menorrhagia rarely seek medical attention.

      Study design

      A total of 705 adolescent girls attended a lecture on menorrhagia, completed an initial anonymous questionnaire, and were asked to participate in a more comprehensive study comprising a detailed bleeding questionnaire, a pictorial blood loss assessment chart, and blood tests.

      Results

      A total of 105 adolescents (15%) reported they had heavy periods on the initial questionnaire. Among the 94 girls who completed the full questionnaire, 34 reported menorrhagia (36%; 95% CI, 26.5%-46.7%). Almost one-third (11 of 34) of these girls did not perceive having menorrhagia according to their response to the initial questionnaire. Menorrhagia was not related to age, years since menarche, or family history of menorrhagia. Among the 62 girls who consented to blood testing, 6 had anemia (9.6%; 95% CI, 3.6%-19.6%), all of whom had bleeding symptoms.

      Conclusion

      Using standardized questionnaires, we were able to identify adolescents with menorrhagia associated with anemia. Importantly, some of these adolescents were not aware of having menorrhagia and/or anemia. Screening programs for menorrhagia in schools could result in better detection of menorrhagia among adolescents and consequent appropriate referral for medical consultation.
      FVIII:C (Factor VIII), HSC (Hospital for Sick Children), PBAC (Pictorial blood loss assessment chart), PBQ (Pediatric Bleeding Questionnaire), PT (Prothrombin time), PTT (Partial thromboplastin time), QoL (Quality of life), VWD (von Willebrand disease), VWF:Ag (von Willebrand factor antigen), VWF:RCo (von Willebrand factor activity)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hallberg L.
        • Hogdahl A.M.
        • Nilsson L.
        • Rybo G.
        Menstrual blood loss: a population study. Variation at different ages and attempts to define normality.
        Acta Obstet Gynecol Scand. 1966; 45: 320-351
        • Demers C.
        • Derzko C.
        • David M.
        • Douglas J.
        Gynaecological and obstetric management of women with inherited bleeding disorders.
        J Obstet Gynaecol Can. 2005; 27: 707-732
        • Lukes A.S.
        • Kadir R.A.
        • Peyvandi F.
        • Kouides P.A.
        Disorders of hemostasis and excessive menstrual bleeding: prevalence and clinical impact.
        Fertil Steril. 2005; 84: 1338-1344
        • Philipp C.S.
        • Dilley A.
        • Miller C.H.
        • Evatt B.
        • Baranwal A.
        • Schwartz R.
        • et al.
        Platelet functional defects in women with unexplained menorrhagia.
        J Thromb Haemost. 2003; 1: 477-484
        • Shankar M.
        • Lee C.A.
        • Sabin C.A.
        • Economides D.L.
        • Kadir R.A.
        von Willebrand disease in women with menorrhagia: a systematic review.
        Br J Obstet Gynaecol. 2004; 111: 734-740
        • Kadir R.A.
        • Economides D.L.
        • Sabin C.A.
        • Owens D.
        • Lee C.A.
        Frequency of inherited bleeding disorders in women with menorrhagia.
        Lancet. 1998; 351: 485-489
        • Philipp C.S.
        • Faiz A.
        • Dowling N.
        • Dilley A.
        • Michaels L.A.
        • Ayers C.
        • et al.
        Age and the prevalence of bleeding disorders in women with menorrhagia.
        Obstet Gynecol. 2005; 105: 61-66
        • Bevan J.A.
        • Maloney K.W.
        • Hillery C.A.
        • Gill J.C.
        • Montgomery R.R.
        • Scott J.P.
        Bleeding disorders: a common cause of menorrhagia in adolescents.
        J Pediatr. 2001; 138: 856-861
        • Brenner P.F.
        Differential diagnosis of abnormal uterine bleeding.
        Am J Obstet Gynecol. 1996; 175: 766-769
        • Ellis M.H.
        • Beyth Y.
        Abnormal vaginal bleeding in adolescence as the presenting symptom of a bleeding diathesis.
        J Pediatr Adolesc Gynecol. 1999; 12: 127-131
        • Ghosh K.
        • Trasi S.
        • Nair S.
        • Shetty S.
        • Mohanty D.
        Prevalence of inherited bleeding disorders in cases of idiopathic menorrhagia: a case of five blind men describing an elephant.
        J Thromb Haemost. 2003; 1: 2242-2243
        • James A.H.
        Bleeding disorders in adolescents.
        Obstet Gynecol Clin North Am. 2009; 36: 153-162
        • Jayasinghe Y.
        • Moore P.
        • Donath S.
        • Campbell J.
        • Monagle P.
        • Grover S.
        Bleeding disorders in teenagers presenting with menorrhagia.
        Aust NZ J Obstet Gynaecol. 2005; 45: 439-443
        • Higham J.M.
        • O’Brien P.M.
        • Shaw R.W.
        Assessment of menstrual blood loss using a pictorial chart.
        Br J Obstet Gynaecol. 1990; 97: 734-739
        • Wyatt K.M.
        • Dimmock P.W.
        • Walker T.J.
        • O’Brien P.M.
        Determination of total menstrual blood loss.
        Fertil Steril. 2001; 76: 125-131
        • Dean J.A.
        • Blanchette V.S.
        • Carcao M.D.
        • Stain A.M.
        • Sparling C.R.
        • Siekmann J.
        • et al.
        von Willebrand disease in a pediatric-based population: comparison of type 1 diagnostic criteria and use of the PFA-100 and a von Willebrand factor/collagen-binding assay.
        Thromb Haemost. 2000; 84: 401-409
        • Hedlund-Treutiger I.
        • Revel-Vilk S.
        • Blanchette V.S.
        • Curtin J.A.
        • Lillicrap D.
        • Rand M.L.
        Reliability and reproducibility of classification of children as “bleeders” versus “non-bleeders” using a questionnaire for significant mucocutaneous bleeding.
        J Pediatr Hematol Oncol. 2004; 26: 488-491
      1. National Heart, Lung, and Blood Institute. Diagnosis, evaluation, and management of von Willebrand disease. NIH publication 08-5832. Available from: www.nhlbi.nih.gov/guidelines/vwd. Accessed May 31, 2010.

        • Seligsohn U.
        Inherited bleeding disorders common in Jews.
        Harefuah. 2010; 149 (in Hebrew): 298-303
        • Friberg B.
        • Orno A.K.
        • Lindgren A.
        • Lethagen S.
        Bleeding disorders among young women: a population-based prevalence study.
        Acta Obstet Gynecol Scand. 2006; 85: 200-206
        • Barr F.
        • Brabin L.
        • Agbaje S.
        • Buseri F.
        • Ikimalo J.
        • Briggs N.
        Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents.
        Public Health Nutr. 1998; 1: 249-257
        • Chan S.S.
        • Yiu K.W.
        • Yuen P.M.
        • Sahota D.S.
        • Chung T.K.
        Menstrual problems and health-seeking behaviour in Hong Kong Chinese girls.
        Hong Kong Med J. 2009; 15: 18-23
        • Pawar A.
        • Krishnan R.
        • Davis K.
        • Bosma K.
        • Kulkarni R.
        Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders.
        Haemophilia. 2008; 14: 579-583
        • Titilayo A.
        • Agunbiade O.M.
        • Banjo O.
        • Lawani A.
        Menstrual discomfort and its influence on daily academic activities and psychosocial relationship among undergraduate female students in Nigeria.
        Tanzan J Health Res. 2009; 11: 181-188
        • Al-Quaiz J.M.
        Iron deficiency anemia: a study of risk factors.
        Saudi Med J. 2001; 22: 490-496
        • Morrison J.
        • Patel S.T.
        • Watson W.
        • Zaidi Q.R.
        • Mangione A.
        • Goss T.F.
        Assessment of the prevalence and impact of anemia on women hospitalized for gynecologic conditions associated with heavy uterine bleeding.
        J Reprod Med. 2008; 53: 323-330
        • Mikhail S.
        • Varadarajan R.
        • Kouides P.
        The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre.
        Haemophilia. 2007; 13: 627-632
        • Kanbur N.O.
        • Derman O.
        • Kutluk T.
        • Gurgey A.
        Coagulation disorders as the cause of menorrhagia in adolescents.
        Int J Adolesc Med Health. 2004; 16: 183-185
        • Philipp C.S.
        • Faiz A.
        • Dowling N.F.
        • Beckman M.
        • Owens S.
        • Ayers C.
        • et al.
        Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation.
        Am J Obstet Gynecol. 2008; 198 (e1-8)
        • Bowman M.
        • Riddel J.
        • Rand M.L.
        • Tosetto A.
        • Silva M.
        • James P.D.
        Evaluation of the diagnostic utility for von Willebrand disease of a pediatric bleeding questionnaire.
        J Thromb Haemost. 2009; 7: 1418-1421
        • Biss T.T.
        • Blanchette V.S.
        • Clark D.S.
        • Bowman M.
        • Wakefield C.D.
        • Silva M.
        • et al.
        Quantitation of bleeding symptoms in children with von Willebrand disease: use of a standardized pediatric bleeding questionnaire.
        J Thromb Haemost. 2010; 8: 950-956
        • Biss T.T.
        • Blanchette V.S.
        • Clark D.S.
        • Wakefield C.D.
        • James P.D.
        • Rand M.L.
        Use of a quantitative pediatric bleeding questionnaire to assess mucocutaneous bleeding symptoms in children with a platelet function disorder.
        J Thromb Haemost. 2010; 8: 1416-1419
        • Revel-Vilk S.
        • Rand M.L.
        An approach to the diagnosis of mild and moderate bleeding disorders in children.
        J Coagul Disord. 2010;