A retrospective review of diagnosis and management of heavy menstrual bleeding and co-morbidities in patients seen in Young Women’s Blood Clinic

Introduction: The prevalence of heavy menstrual bleeding (HMB) is estimated as high as 37% in adolescents and is associated with co-morbidities, such as bleeding disorders (BD), iron deficiency anemia (IDA) and mood disorders. The Young Women's Blood Clinic (YWBC) is a multidisciplinary clinic in Hamilton, Ontario staffed with a gynaecologist, hematologist and nurse to provide diagnosis and management of HMB. This study was conducted to evaluate the diagnosis and management of HMB along with co-morbidities such as BD and IDA in adolescents seen at YWBC. Methods: This is a retrospective cohort study between July 2017 and June 2021. Patient records were reviewed for demographics, laboratory parameters, management plans and outcomes. Results: One hundred and three new patients with HMB were seen in the monthly YWBC during the study period. Four patients were referred with pre-existing BDs (2 von Willebrand Disease (vWD), 1 factor XI deficiency, 1 factor VII deficiency), while 4/101 (3.9%) were newly diagnosed (4 vWD). On presentation, 38 (36.9%) had IDA, while 43 patients (41.7%) had iron deficiency (ID) alone. Sixty-eight patients were treated with oral iron, while 13 required IV iron and 15 required blood transfusions. Oral contraceptive pills are the most common management option for patients diagnosed with and without BDs. Fifty-five point eight percent of patients reported improvement in HMB after 1st line treatment, 12.8% with 2nd line, 11.6% with third line or more, while 26.7% of patients reported ongoing HMB or had missing data. Conclusion: HMB can be debilitating and requires coordinated multidisciplinary care to diagnose and manage adequately.