Hemostatic testing may explain heavy menstrual bleeding

By Nikki Withers, medwireNews Reporter

Results of a US study show that hemostatic screening tests are important in the evaluation of young women with heavy menstrual bleeding (HMB).

The researchers found that 62% of adolescents referred to a specialty hematology clinic with HMB - defined as bleeding lasting more than 7 days or resulting in the loss of more than 80 mL per menstrual cycle - had an underlying bleeding disorder that was not identified by a standardized questionnaire.

A total of 105 patients aged between 8 and 18 years and with medical records available were included in the study. All patients were referred for HMB to the Multidisciplinary Adolescent Haematology Clinic at Nationwide Children's hospital between February 2009 and December 2011.

At the time of their initial visit, all patients completed a menstrual bleeding questionnaire based on the Ruta Menorrhagia Severity Scale.

Overall, a high proportion of patients (62%) were diagnosed with a bleeding disorder. Specifically, 37% were diagnosed with platelet storage pool deficiency, 9% with von Willebrand's disease, 8% with other platelet function defects, 7% with Ehlers-Danlos syndrome, and 2% with combined bleeding disorders.

Of note, when the researchers used the modified Ruta Menorrhagia Severity Scale to compare the bleeding profiles of females with and without a bleeding disorder they found that only three factors significantly differed between the two groups. These included the reported regularity of periods, description of period flow, and the number of days a period was described as "heavy."

"In our small population, menstrual bleeding profiles, as examined by a standardized questionnaire, could not identify females with an underlying bleeding disorder," write Sara O'Brian (Nationwide Children's Hospital, Columbus, Ohio) and colleagues in Haemophilia.

"Our results draw attention to the role of specialty haematology clinics in performing haemostasis testing in the evaluation of adolescents with HMB," they say.

"Identifying the underlying diagnosis is the first critical step in the optimal treatment and management of young women with HMB caused by bleeding disorders."

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