p.3
Pathological Causes of HMB in Adolescents
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.
p.5
Medical Treatment Options for Adolescent HMB
What are some side effects of Tranexamic acid?
Nausea, vomiting, diarrhoea, allergic dermatitis, colour vision changes, seizure, thrombosis.
p.6
Medical Treatment Options for Adolescent HMB
What should be considered when using the implant (Nexplanon) in patients under 18?
It is not licensed for use under 18 years.
p.5
Medical Treatment Options for Adolescent HMB
What are the contraindications for Mefenamic acid?
Active gastrointestinal bleeding or ulceration, caution in cardiac disease.
p.5
Medical Treatment Options for Adolescent HMB
What are some side effects of combined hormonal contraception?
Unscheduled bleeding, headaches, mood changes, breast tenderness.
p.1
Impact of HMB on Quality of Life and Education
What are the psychosocial consequences of HMB in adolescents?
Higher rates of fatigue, decreased verbal learning and memory, depression, and school absenteeism.
p.2
Clinical Evaluation and History Taking for HMB
Why should the clinical history be taken both with and without a parent or carer present?
To explore sensitive or confidential subjects effectively.
p.9
Clinical Evaluation and History Taking for HMB
What is the significance of screening for bleeding disorders in hospitalized adolescents?
Bleeding disorders have a higher prevalence in the hospitalized population.
p.5
Medical Treatment Options for Adolescent HMB
What is a notable characteristic of Co-cyprindiol (Dianette)?
It has a higher VTE risk than second-generation progesterones.
p.8
Medical Treatment Options for Adolescent HMB
What is a safe alternative to medroxyprogesterone for managing acute heavy menstrual bleeding?
Norethisterone 10 – 30 mg daily.
p.6
Medical Treatment Options for Adolescent HMB
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).
p.4
Clinical Evaluation and History Taking for HMB
Who primarily manages patients with heavy menstrual bleeding?
A gynecologist with a specialist interest in pediatric and adolescent gynecology.
p.9
Follow-Up and Long-Term Management Strategies
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.
p.1
Management of Acute Heavy Menstrual Bleeding
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.
p.2
Investigative Approaches for HMB in Adolescents
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.
p.2
Clinical Evaluation and History Taking for HMB
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.
p.4
Impact of HMB on Quality of Life and Education
What should be considered when managing heavy menstrual bleeding in adolescents?
Their physical, psychological, and social wellbeing.
p.2
Clinical Evaluation and History Taking for HMB
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.
p.4
Role of Hormonal Contraceptives in Managing HMB
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.
p.5
Medical Treatment Options for Adolescent HMB
What is a significant risk factor for using combined hormonal contraception?
BMI ≥ 35, personal history or first-degree relative with history of VTE.
p.6
Medical Treatment Options for Adolescent HMB
What is a contraindication for using the combined vaginal ring (NuvaRing)?
Avoid where not sexually active.
p.3
Pathological Causes of HMB in Adolescents
What is the most common platelet disorder in adolescence?
Immune thrombocytopenia (ITP).
p.3
Pathological Causes of HMB in Adolescents
What is a hallmark feature of Polycystic Ovary Syndrome (PCOS)?
Oligo- or amenorrhoea, hirsutism, and acne.
p.5
Medical Treatment Options for Adolescent HMB
What contraindications are associated with Tranexamic acid?
Fibrinolytic conditions, history of convulsions, thromboembolic disease.
p.4
Medical Treatment Options for Adolescent HMB
What should clinicians use to assess the safety of prescribing contraceptive treatments?
The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC).
p.5
Medical Treatment Options for Adolescent HMB
What is the first-line oral contraceptive for managing heavy menstrual bleeding?
Combined hormonal contraception such as Microgynon 30.
p.5
Medical Treatment Options for Adolescent HMB
What is the dosing schedule for Qlaira?
1 active tablet for 26 days then 1 inactive tablet for 2 days.
p.3
Pathological Causes of HMB in Adolescents
What is the most common bleeding disorder in the UK?
Von Willebrand disease (VWD).
p.5
Medical Treatment Options for Adolescent HMB
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).
p.6
Medical Treatment Options for Adolescent HMB
What is a potential complication of the depot injection (Depo-provera)?
Long-term use (> 5 years) is associated with osteopenia.
p.5
Medical Treatment Options for Adolescent HMB
What is the maximum dose of Mefenamic acid for adolescents aged 12-17?
500 mg up to 4 times a day.
p.7
Ethical Considerations in Adolescent Healthcare
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.
p.2
Investigative Approaches for HMB in Adolescents
What is the role of ultrasound in the evaluation of adolescents with HMB?
To characterize pelvic masses or assess congenital uterine anomalies.
p.7
Medical Treatment Options for Adolescent HMB
What are combined hormonal contraceptives (CHCs) commonly used for in adolescents?
As first-line therapy for heavy menstrual bleeding (HMB) secondary to bleeding disorders.
p.3
Pathological Causes of HMB in Adolescents
What are the three main types of Von Willebrand disease?
Type 1 (mildest form), Type 2 (functional abnormality), and Type 3 (severe deficiency).
p.6
Medical Treatment Options for Adolescent HMB
What is a significant risk associated with long-term use of progestogens?
Long-term use is associated with hepatic adenomas.
p.7
Medical Treatment Options for Adolescent HMB
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.
p.1
Ethical Considerations in Adolescent Healthcare
What ethical considerations must be balanced in adolescent healthcare regarding HMB?
Duties of confidentiality must be balanced against safeguarding concerns.
p.4
Medical Treatment Options for Adolescent HMB
What is the recommended treatment for adolescents who are medically eligible for heavy menstrual bleeding (HMB)?
Depot medroxyprogesterone acetate (DMPA) injection.
p.6
Medical Treatment Options for Adolescent HMB
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.
p.4
Medical Treatment Options for Adolescent HMB
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.
p.7
Medical Treatment Options for Adolescent HMB
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.
p.7
Ethical Considerations in Adolescent Healthcare
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.
p.6
Medical Treatment Options for Adolescent HMB
What are the side effects associated with the combined transdermal patch (Evra)?
As above (referring to side effects of other hormonal treatments).
p.7
Medical Treatment Options for Adolescent HMB
What is the risk associated with norethisterone 5 mg TDS?
Increased risk of venous thromboembolism (VTE).
p.6
Medical Treatment Options for Adolescent HMB
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.
p.7
Medical Treatment Options for Adolescent HMB
What is a first-line progestogen-only pill for adolescents with HMB?
Desogestrel 75 mcg once daily.
p.9
Investigative Approaches for HMB in Adolescents
What diagnostic tests are recommended for hospitalized adolescent girls with heavy menstrual bleeding?
Pelvic ultrasound and screening for underlying bleeding disorders.
p.4
Role of Hormonal Contraceptives in Managing HMB
What is the role of combined hormonal contraceptives in treating HMB?
They are first-line treatments for adolescents without contraindications.
p.2
Investigative Approaches for HMB in Adolescents
What initial investigations are recommended for adolescents presenting with HMB?
A full blood count (FBC) and ferritin check, along with a coagulation screen.
p.2
Clinical Evaluation and History Taking for HMB
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.
p.1
Understanding Heavy Menstrual Bleeding (HMB) in Adolescents
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.
p.7
Medical Treatment Options for Adolescent HMB
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.
p.2
Clinical Evaluation and History Taking for HMB
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.
p.3
Pathological Causes of HMB in Adolescents
How can chronic systemic diseases affect menstrual bleeding?
They can lead to heavy or irregular cycles due to treatments or underlying conditions.
p.7
Follow-Up and Long-Term Management Strategies
What should patients receive after their outpatient appointment?
A written copy of their treatment plan.
p.1
Pathological Causes of HMB in Adolescents
What is the most common cause of heavy menstrual bleeding (HMB) in adolescents?
Anovulatory cycles resulting from hypothalamic-pituitary ovarian (HPO) axis immaturity.
p.4
Management of Acute Heavy Menstrual Bleeding
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).
p.9
Management of Acute Heavy Menstrual Bleeding
What should be done until the bleeding in adolescent girls has stabilized?
Girls should remain inpatient.
p.3
Pathological Causes of HMB in Adolescents
What is Ehlers Danlos syndrome (EDS) associated with?
Heavy menstrual bleeding (HMB) due to platelet functional abnormalities.
p.9
Impact of HMB on Quality of Life and Education
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.
p.3
Pathological Causes of HMB in Adolescents
What medications can potentiate androgen biosynthesis leading to heavy menstrual bleeding?
Sodium valproate, carbamazepine, oxcarbazepine, and lamotrigine.
p.2
Investigative Approaches for HMB in Adolescents
What types of screening should be performed in sexually active adolescents with abnormal vaginal bleeding?
STI screening and a urinary pregnancy test.
p.9
Medical Treatment Options for Adolescent HMB
What are the mainstays of treatment for adolescent heavy menstrual bleeding?
Tranexamic acid, NSAIDs, and hormonal therapy.
p.2
Pathological Causes of HMB in Adolescents
What should be considered in adolescents presenting with HMB from the onset?
The possibility of bleeding disorders.
p.5
Medical Treatment Options for Adolescent HMB
What is the benefit of using Yasmin for heavy menstrual bleeding?
It has an anti-androgen component useful for acne and higher VTE risk.
p.8
Management of Acute Heavy Menstrual Bleeding
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.
p.8
Medical Treatment Options for Adolescent HMB
What is preferred for girls with learning disabilities experiencing heavy menstrual bleeding?
Continuous or long-acting preparations with high amenorrhoea rates.
p.8
Medical Treatment Options for Adolescent HMB
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.
p.8
Medical Treatment Options for Adolescent HMB
What should be considered when prescribing hormonal treatments to adolescents?
Co-morbidities and drug interactions, especially with anti-epileptic medications.
p.8
Medical Treatment Options for Adolescent HMB
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.
p.8
Role of Hormonal Contraceptives in Managing HMB
What is a common choice to reduce menstrual severity and allow scheduling of withdrawal bleeds?
Continuous extended use combined hormonal contraception (CHC).
p.8
Management of Acute Heavy Menstrual Bleeding
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.
