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Evidence to Improve Care

Heavy Menstrual Bleeding

Care for Adults and Adolescents of Reproductive Age


13

Bleeding Disorders in Adolescents

Adolescents with heavy menstrual bleeding are screened for risk of inherited bleeding disorder, using a structured assessment tool.


Almost half of adolescents presenting with heavy menstrual bleeding at or closely following menarche have an underlying bleeding disorder. Clinicians should ask if the patient has had heavy menstrual bleeding since menarche and if they have had postpartum hemorrhage, surgery-related bleeding, or bleeding associated with dental work. If the patient answers “yes” to any of the above questions, clinicians should use a structured bleeding assessment tool to also ask about bruising, nose bleeds, frequent gum bleeding, blood in urine, and a family history of bleeding symptoms. Additional laboratory evaluations are necessary if the patient has a positive screen for inherited coagulopathy.

For Patients

If you are an adolescent, you should be asked about your bleeding history and perhaps have extra blood tests.


For Clinicians

If your patient is an adolescent presenting with heavy menstrual bleeding at or close to menarche, use a structured bleeding assessment tool to screen for risk of inherited bleeding disorders. If your patient screens positive using this tool, consult with a hematologist and test your patient for bleeding disorders.


For Health Services

Ensure systems, processes, and resources are in place such that patients have access to hematological consultation if needed and the laboratory facilities to test for bleeding disorders.

Process Indicator

Percentage of patients with heavy menstrual bleeding aged 10 to 19 years who are screened for risk of inherited bleeding disorder

  • Denominator: number of patients with heavy menstrual bleeding aged 10 to 19 years

  • Numerator: number of patients in the denominator who are screened for risk of inherited bleeding disorder

  • Data source: local data collection

Adolescents

Adolescence is the period of human growth and development that occurs after childhood and before adulthood. For the purpose of this quality standard, we define this as ages 10 to 19 years.

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