What is the prevalence range of HMB in adolescents according to population-based studies?
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4.8% to 37%.
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What is the prevalence range of HMB in adolescents according to population-based studies?
4.8% to 37%.
What clinical features may indicate hypothyroidism as a cause of heavy menstrual bleeding?
Heavy or irregular menstrual bleeding, goitre, fatigue, myalgia, cold sensitivity, and low mood.
What are some side effects of Tranexamic acid?
Nausea, vomiting, diarrhoea, allergic dermatitis, colour vision changes, seizure, thrombosis.
What should be considered when using the implant (Nexplanon) in patients under 18?
It is not licensed for use under 18 years.
What are the contraindications for Mefenamic acid?
Active gastrointestinal bleeding or ulceration, caution in cardiac disease.
What are some side effects of combined hormonal contraception?
Unscheduled bleeding, headaches, mood changes, breast tenderness.
What are the psychosocial consequences of HMB in adolescents?
Higher rates of fatigue, decreased verbal learning and memory, depression, and school absenteeism.
Why should the clinical history be taken both with and without a parent or carer present?
To explore sensitive or confidential subjects effectively.
What condition is characterized by chronic pelvic pain and heavy menstrual bleeding in adolescents?
Endometriosis.
What is the most common cause of adolescent heavy menstrual bleeding?
HPO axis immaturity.
What is the significance of screening for bleeding disorders in hospitalized adolescents?
Bleeding disorders have a higher prevalence in the hospitalized population.
What is a notable characteristic of Co-cyprindiol (Dianette)?
It has a higher VTE risk than second-generation progesterones.
What is a safe alternative to medroxyprogesterone for managing acute heavy menstrual bleeding?
Norethisterone 10 – 30 mg daily.
What is the dosage and application method for the combined transdermal patch (Evra)?
Ethinylestradiol 33.9 mcg / Norelgestromin 203 mcg/24h applied below the waist weekly for weeks 1-3 of the cycle (week 4 patch free).
Who primarily manages patients with heavy menstrual bleeding?
A gynecologist with a specialist interest in pediatric and adolescent gynecology.
What is the predominant medical treatment for adolescent HMB?
Hormonal contraceptives.
What should be included in the follow-up plan upon discharge?
Ongoing medication planning, contact details for clinical nurse specialists, online resources, and a follow-up review.
What framework is suggested for assessing and managing acute adolescent HMB?
A specific framework is provided within the article, though details are not specified here.
When should further investigations be considered for adolescents with HMB?
If they fail to respond to medical therapy or if an underlying pathological cause is suspected.
What is the recommended dosage for Norethisterone to arrest bleeding?
5 mg TDS for 21 days.
What is the importance of creating a comfortable clinical environment for adolescents presenting with HMB?
It helps reduce anxiety and empowers them to express their opinions and concerns about their symptoms and treatment.
What should be considered when managing heavy menstrual bleeding in adolescents?
Their physical, psychological, and social wellbeing.
What is recommended for girls to aid in the evaluation of their menstrual cycles?
Keeping a diary of their menstrual cycles on a phone app or paper.
What is the effect of combined oral contraceptive pills (COCP) on menstrual blood flow?
They reduce menstrual blood flow compared to placebo after 6 months of use.
What is a significant risk factor for using combined hormonal contraception?
BMI ≥ 35, personal history or first-degree relative with history of VTE.
What is a contraindication for using the combined vaginal ring (NuvaRing)?
Avoid where not sexually active.
What is the most common platelet disorder in adolescence?
Immune thrombocytopenia (ITP).
What is a hallmark feature of Polycystic Ovary Syndrome (PCOS)?
Oligo- or amenorrhoea, hirsutism, and acne.
What contraindications are associated with Tranexamic acid?
Fibrinolytic conditions, history of convulsions, thromboembolic disease.
What should clinicians use to assess the safety of prescribing contraceptive treatments?
The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC).
What is the first-line oral contraceptive for managing heavy menstrual bleeding?
Combined hormonal contraception such as Microgynon 30.
What is the dosing schedule for Qlaira?
1 active tablet for 26 days then 1 inactive tablet for 2 days.
What is the most common bleeding disorder in the UK?
Von Willebrand disease (VWD).
What is the desired outcome of using progestogen-only preparations in adolescents?
Amenorrhoea.
What is the recommended dose of Tranexamic acid for adolescents aged 12-17?
1 g three times a day up to 4 days (maximum 4 g/day).
What is a potential complication of the depot injection (Depo-provera)?
Long-term use (> 5 years) is associated with osteopenia.
What is the maximum dose of Mefenamic acid for adolescents aged 12-17?
500 mg up to 4 times a day.
What is required for adolescents to provide informed consent for treatment?
They must understand the proposed treatment, risks, benefits, and alternatives, and communicate their decision freely.
What is the role of ultrasound in the evaluation of adolescents with HMB?
To characterize pelvic masses or assess congenital uterine anomalies.
What are combined hormonal contraceptives (CHCs) commonly used for in adolescents?
As first-line therapy for heavy menstrual bleeding (HMB) secondary to bleeding disorders.
What are the three main types of Von Willebrand disease?
Type 1 (mildest form), Type 2 (functional abnormality), and Type 3 (severe deficiency).
What is a significant risk associated with long-term use of progestogens?
Long-term use is associated with hepatic adenomas.
What is the mean age of menarche in the UK?
12 to 13 years old.
What should be considered when fitting an LNG-IUS in adolescents?
Specific groups may benefit from placement under general anaesthesia, such as those who are not sexually active or have learning disabilities.
What ethical considerations must be balanced in adolescent healthcare regarding HMB?
Duties of confidentiality must be balanced against safeguarding concerns.
What is the recommended treatment for adolescents who are medically eligible for heavy menstrual bleeding (HMB)?
Depot medroxyprogesterone acetate (DMPA) injection.
What are the side effects of Medroxy-progesterone acetate (Provera)?
Breast abnormalities, mood changes, increased appetite, fluid retention, constipation, skin reactions, irregular menstrual bleeding, weight gain.
What is the recommended dosage of tranexamic acid for HMB?
500 – 1000 mg three times a day from the onset of menstruation for up to 4 days.
How long does a typical adolescent period last?
Between 2 to 7 days.
What is the role of DMPA in adolescent HMB treatment?
It is an alternative when CHCs are contraindicated or when there are compliance difficulties with oral medication.
What consent form is needed for the insertion of an LNG-IUS under anaesthetic in the UK?
A consent form is required, with specific forms for different age groups.
What are the side effects associated with the combined transdermal patch (Evra)?
As above (referring to side effects of other hormonal treatments).
What is the risk associated with norethisterone 5 mg TDS?
Increased risk of venous thromboembolism (VTE).
What is the effectiveness of the LNG-IUS (Mirena) in reducing heavy menstrual bleeding?
Significantly more effective in reducing HMB than oral progestogens or COCP.
What is a first-line progestogen-only pill for adolescents with HMB?
Desogestrel 75 mcg once daily.
What is the first-line non-hormonal therapy for heavy menstrual bleeding?
Tranexamic acid.
What diagnostic tests are recommended for hospitalized adolescent girls with heavy menstrual bleeding?
Pelvic ultrasound and screening for underlying bleeding disorders.
What is the role of combined hormonal contraceptives in treating HMB?
They are first-line treatments for adolescents without contraindications.
What initial investigations are recommended for adolescents presenting with HMB?
A full blood count (FBC) and ferritin check, along with a coagulation screen.
What should be included in the sexual history of adolescents presenting with HMB?
Details and ages of partners, and assessment of any potential safeguarding concerns.
What percentage of patients with vascular liver diseases experienced heavy menstrual bleeding (HMB)?
21%.
What defines heavy menstrual bleeding (HMB) according to NICE?
Excessive menstrual loss impacting quality of life, or changing sanitary products every 1-2 hours or menses lasting longer than 7 days.
What is the LNG-IUS and its effectiveness in treating HMB?
It is more effective in reducing excessive menstrual loss than other treatments and can lead to amenorrhoea or reduced blood loss.
What should the clinical history focus on when evaluating HMB?
Frequency and heaviness of bleeding, associated symptoms, risk factors, quality of life impact, and safeguarding issues.
How can chronic systemic diseases affect menstrual bleeding?
They can lead to heavy or irregular cycles due to treatments or underlying conditions.
What should patients receive after their outpatient appointment?
A written copy of their treatment plan.
What is the most common cause of heavy menstrual bleeding (HMB) in adolescents?
Anovulatory cycles resulting from hypothalamic-pituitary ovarian (HPO) axis immaturity.
When should adolescents with heavy menstrual bleeding be admitted to an acute gynecology unit?
If bleeding heavily, haemodynamically compromised, or significantly anaemic (Hb < 80 g/dl).
What should be done until the bleeding in adolescent girls has stabilized?
Girls should remain inpatient.
What is Ehlers Danlos syndrome (EDS) associated with?
Heavy menstrual bleeding (HMB) due to platelet functional abnormalities.
What are the potential impacts of untreated heavy menstrual bleeding (HMB) in adolescents?
It can significantly affect future education and employment attainment, contributing to the gender health gap.
What medications can potentiate androgen biosynthesis leading to heavy menstrual bleeding?
Sodium valproate, carbamazepine, oxcarbazepine, and lamotrigine.
What types of screening should be performed in sexually active adolescents with abnormal vaginal bleeding?
STI screening and a urinary pregnancy test.
What is the first-line treatment in the management of acute heavy menstrual bleeding?
Hormonal therapy.
What are the mainstays of treatment for adolescent heavy menstrual bleeding?
Tranexamic acid, NSAIDs, and hormonal therapy.
What should be considered in adolescents presenting with HMB from the onset?
The possibility of bleeding disorders.
What is the benefit of using Yasmin for heavy menstrual bleeding?
It has an anti-androgen component useful for acne and higher VTE risk.
What should be done if a patient presents with significant anaemia or bleeding with haemodynamic compromise?
Blood products should be replaced, starting with group-specific packed red cells.
What is the recommended time frame for a medical review after starting hormonal therapy for adolescents?
6 months.
What is preferred for girls with learning disabilities experiencing heavy menstrual bleeding?
Continuous or long-acting preparations with high amenorrhoea rates.
What should the medical review focus on for adolescents undergoing hormonal therapy?
Current symptoms, compliance to therapy, acceptability of treatment, and impact on quality of life.
What should be considered when prescribing hormonal treatments to adolescents?
Co-morbidities and drug interactions, especially with anti-epileptic medications.
What is the role of tranexamic acid in the management of acute heavy menstrual bleeding?
It is commonly used in the acute setting, though studies in adolescents are lacking.
What is a common choice to reduce menstrual severity and allow scheduling of withdrawal bleeds?
Continuous extended use combined hormonal contraception (CHC).
What initial assessments should be conducted for a patient presenting with acute heavy menstrual bleeding?
Full blood count, coagulation screen, group and save, urea & electrolytes, and venous blood gas.
