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Heavy menstrual bleeding (HMB) can significantly affect an adolescent’s physical, social, emotional, and material quality of life. It often leads to serious health complications, including anemia, and presents a major public health issue. Hematologists have shed light on the causes, measurement challenges, and treatment options for HMB, offering new insights into managing this common yet often misunderstood condition.
The Scope of the Problem
Approximately 90% of adolescents with HMB experience low ferritin levels, and around 70% develop anemia, noted Dr. Juliana Perez Botero, a benign hematologist from the Mayo Clinic. Speaking at the 2024 Annual Meeting of the American Society of Hematology (ASH), Dr. Botero highlighted the substantial public health implications of HMB and stressed the gender equality and social justice aspects of addressing this issue.
Measuring Heavy Menstrual Bleeding
According to Dr. Allison Wheeler, a hematologist at the University of Washington, defining what constitutes “heavy” menstrual bleeding has long been a challenge. While traditional definitions of HMB involve blood loss of more than 80 milliliters or bleeding lasting more than seven days, newer guidelines focus on the impact of menstrual blood loss on a person’s quality of life. “The most important measure of heavy menstrual bleeding is how it interferes with the patient’s life,” Wheeler explained.
Measuring menstrual blood loss remains difficult. The alkaline hematin method, considered the gold standard for assessing blood loss, involves measuring blood in feminine hygiene products. However, other tools like the Pictorial Blood Loss Assessment Chart and the Adolescent Menstrual Bleeding Questionnaire allow patients to estimate blood loss and provide insights into quality of life, though these methods have their limitations.
Treatment Options for Heavy Menstrual Bleeding
Treatment for heavy menstrual bleeding can be more straightforward—and surprising—than many might expect. For instance, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), commonly used for pain relief, can also reduce menstrual blood loss. Although it may seem counterintuitive, NSAIDs work by decreasing prostaglandin levels in the endometrium, which can help regulate bleeding. A meta-analysis comparing NSAIDs with placebo revealed a reduction in menstrual bleeding similar to that of estrogen-progesterone formulations.
Dr. Wheeler emphasized the importance of optimizing NSAID dosage for effective results. “Lower or sporadic doses won’t work,” she cautioned.
Other Treatment Options
Tranexamic acid, an antifibrinolytic medication, is another common treatment. It stabilizes blood clots, preventing excessive bleeding. According to Dr. Wheeler, clinical trials have shown that tranexamic acid does not increase the risk of venous or arterial thrombosis, though patients with a history of thrombosis were excluded from most trials. Side effects are typically mild and include headaches or stomach discomfort.
Hormone management, using estrogen and progesterone therapy, is another option. This treatment stabilizes the endometrium, reducing bleeding. However, it may take 3-6 months to show full results, and Dr. Wheeler highlighted potential side effects, including irregular bleeding, particularly with progesterone-only therapy.
Final Thoughts
The management of heavy menstrual bleeding can significantly improve an adolescent’s quality of life and overall health. Hematologists play a crucial role in diagnosing and treating this condition, and the availability of various treatments—from NSAIDs to hormonal therapies—offers patients and healthcare providers effective solutions.
Disclaimer: This article provides an overview of current treatment options and approaches for heavy menstrual bleeding. It is not intended as medical advice. Please consult with a healthcare professional for personalized treatment options and care.
