Management of heavy menstrual bleeding in a multidisciplinary young women’s clinic: a Dutch experience

Abstract

Background: Heavy menstrual bleeding (HMB) is common in young women. It may lead to iron deficiency with or without anemia, decreased school, work, sport, and social participation, and may be the first sign of underlying bleeding disorders (BDs). Objectives: To study the prevalence of BDs, initial and effective management of HMB and iron deficiency (anemia) in young women referred to a tertiary multidisciplinary HMB clinic. Methods: This was a retrospective, single-center chart review evaluating patients aged ≤25 years who visited the multidisciplinary HMB clinic between March 2018 and December 2023. Results: In total, 200 patients (median age, 15 years) were included. At first consultation, BD was already diagnosed in 47 (24%) patients, particularly von Willebrand disease (n = 27). In 32 of 153 (21%) remaining patients, a new BD was diagnosed (von Willebrand disease, n = 21; platelet aggregation defect, n = 8). Initial therapy of HMB mainly consisted of tranexamic acid with (n = 52, 26%) or without (n = 50, 30%) combined oral contraceptive pill. In 60 patients (30%), initial therapy was effective. Effective HMB management was mostly achieved with tranexamic acid combined with a combined oral contraceptive pill (n = 75, 38%) after a median of 1 treatment change (range, 0-10). Iron deficiency was present in 52% of patients, with approximately half having anemia. Treatment consisted of oral and/or intravenous iron supplementation in 77 patients and red blood cell transfusion in 9 patients. Conclusion: BDs and iron deficiency (anemia) were common in young women with HMB. Multiple treatment strategies were needed to achieve an acceptable outcome. A multidisciplinary approach may offer complementary expertise in this patient group.

Keywords

• hemorrhagic disorders
• iron deficiency
• menorrhagia
• oral contraceptives
• tranexamic acid
• von Willebrand disease