Evaluation and management of heavy menstrual bleeding in adolescents

Curr Opin Obstet Gynecol. 2017 Oct;29(5):328-336. doi: 10.1097/GCO.0000000000000394.


Purpose of review: Heavy menstrual bleeding (HMB) is a common condition in women of reproductive age; however, adolescents with this issue present unique challenges in both diagnosis and management. Much of the research into this topic focuses on the adult population, with variable applicability to adolescents. There are currently no standard guidelines for the work up and treatment of adolescents with HMB.

Recent findings: Current research into this topic has explored the utilization of standardized protocols in the evaluation of HMB in adolescents, the efficacy of various hormonal, nonhormonal, and surgical treatment modalities, and the benefits of a multidisciplinary approach. Recent literature has focused on adolescents found to have an underlying bleeding disorder, recommending more comprehensive bleeding disorder work up to identify these patients in a timely manner and initiate effective treatment plans.

Summary: Providers in the primary care setting should be aware of the definitions for normal menses, and be able to recognize abnormal bleeding and HMB. Early recognition of HMB in adolescents can then lead to appropriate diagnosis of underlying disorders, and current research has proposed standard protocols to assist with the evaluation, ultimately leading to effective long-term management into adulthood.VIDEO ABSTRACT.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Contraceptives, Oral, Combined / therapeutic use
  • Diagnosis, Differential
  • Estrogens / therapeutic use
  • Female
  • Humans
  • Menorrhagia / diagnosis*
  • Menorrhagia / drug therapy*
  • Menorrhagia / etiology
  • Menorrhagia / surgery
  • Progesterone / therapeutic use


  • Anti-Inflammatory Agents, Non-Steroidal
  • Contraceptives, Oral, Combined
  • Estrogens
  • Progesterone