Adolescent Gynaecology – Heavy Menstrual Bleeding


Some women experience heavy menstrual bleeding during their adolescent years. This experience can be uncomfortable and can require additional attention to gynaecological health to ensure discomfort and any adverse health effects are minimised. Normal menstrual bleeding requires tampons and pads to be changed at >3 hour intervals, seldom overnight and fewer than 21 pads/tampons per menstrual cycle. Excessive menstrual bleeding is characterised as a period lasting more than 7 days or with more than 80mL of discharge.

If a woman’s period is necessitating changing a pad or tampon more than every 2 hours this can be characterised as heavy menstrual bleeding. It’s worth seeing your gynaecologist to discuss what this means for you.

Causes of Heavy Menstrual Bleeding In Adolescents

The most common cause of heavy menstrual bleeding in adolescents is anovulatory cycles. The anovulatory cycle is a menstrual cycle characterised by varying degrees of menstrual intervals and the absence of ovulation. In the absence of ovulation there will be infertility.

Other causes of heavy menstrual bleeding include:

  • Endocrine: anovulatory, thyroid dysfunction, polycystic ovarian syndrome (PCOS).
  • Haematological: von Willebrand Disease, platelet function disorder, thrombocytopenia, other bleeding disorder.
  • Medication: hormonal contraception, anticoagulants.
  • Other: trauma, infection, malignancy, structural causes (uncommon in adolescence), gastrointestinal bleeding.

It’s worth remembering that menstrual cycles are often irregular and anovulatory in the first few years after menarche (the first period). So, if heavy and anovulatory bleeding is present during this time, book an appointment with your gynaecologist as soon as possible, but don’t worry too much.

Examinations for Heavy Menstrual Bleeding

An examination for heavy menstrual bleeding will rarely be indicated in an adolescent. However, should a senior clinician be required, they will examine vital signs for hypotension (low blood pressure) or tachycardia (increased heart rate). Skin will be observed for pallor, petechiae (brown/purple spots) or bruising. The abdominal area will be checked for tenderness or excess pelvic mass and the patient will be checked for secondary signs of polycystic ovary syndrome: acne, excess facial or body hair or weight gain.

Investigations can include:

  • FBE (full blood examination)
  • Blood group and antibody screen for severe bleeding
  • Ferritin
  • Coagulation screen
  • TSH (thyroid stimulating hormone blood test)
  • Urine or blood ßhCG (with consent)
  • Consider pelvic ultrasound if bleeding accompanied by pain or palpable mass

Treatments for Heavy Menstrual Bleeding

Mild bleeding with a normal haemoglobin content can be managed with professional reassurance, non-hormonal treatments and observations. Pregnancy related bleeding and bleeding disorders, however, require more attention; potentially hormonal therapy to stabilise the endometrium. Severe cases of heavy menstrual bleeding in adolescents may require IV access, fluid bolus and resuscitation, tranexamic acid, a high dose of norethisterone, iron infusion or transfusion of packed red blood cells (TPBC). Inpatient observation may be required as part of treatment.

Contact Dr Nicole Stamatopoulos

If you or your adolescent experience menstrual bleeding heavier than normal, it’s worth scheduling an appointment with your local gynaecologist/obstetrician Dr Nicole Stamatopoulos to make sure the issue is not of a severe nature. Dr Nicole is available on Mondays and Fridays between 9:00am and 5:00pm to consult you about any women’s health issue you are facing. Contact Dr Nicole by calling 0408 444 306.