Life is a series of firsts – first smiles, first steps, first words, first days of school. For mothers and daughters, a uniquely female first occurs when a girl has her first menstrual period. This transition from child to woman is simultaneously exciting and challenging.
Many girls complain about their period, saying it’s too long, the cramps are too bad or they’re bleeding too much. Is there such a thing as too much bleeding or too long a period?
Recently, a young patient at the University of Miami Pediatric Hemophilia Treatment Center learned her periods were irregular. Only 13 years old, she was admitted to the pediatric inpatient unit after she fainted. She had started a heavy menstrual period two weeks earlier.
The patient needed to change double overnight pads every one to two hours, day and night. The double pads were completely soaked. She had her first period at age 12, and this bleeding pattern was consistent.
The patient had always bruised easily. When she had her tonsils removed at age 10 she returned to the operating room eight days later because she was bleeding heavily from her mouth.
The patient’s mother, aunts and cousins on her mother's side had similar periods, and it was considered normal for the family. The patient always had low iron and was anemic in the emergency room. The patient had fainted because she had lost too much blood.
The patient received a blood transfusion, and she was prescribed oral contraceptive pills to slow the bleeding and regulate her cycle. She was also seen by pediatric hematology. A hematologist, or blood expert, working in partnership with the patient, parents, primary-care physician and, often, a gynecologist, can make a diagnosis and normalize a girl’s periods and lifestyle.
In this case, the patient said she felt very tired and was sick of her periods. She wouldn’t wear light colored clothing for fear of staining her clothes. She didn't want to go to the beach or pool. She had changed, according to her mom, from outgoing and social to sad and isolated.
Heavy and/or irregular menstrual bleeding is common during early adolescence. This patient’s experience was unusual and suggested another explanation. Her personal and family history suggested that a bleeding disorder ran in her family.
Many physicians believe that only men and boys can have an inherited bleeding disorder, particularly hemophilia. However, women can also have an inherited bleeding tendency.
Fifteen percent to 25 percent of women with iron deficiency actually have a bleeding disorder. While boys with hemophilia experience joint and muscle bleeding, girls and women with a bleeding disorder have unusually heavy reproductive bleeding, including menstrual periods or bleeding after childbirth.
One blood disorder diagnosis that a hematologist might consider in these instances is a platelet problem. Platelets, which allow blood to clot, might not be sticking together well or be too few to act effectively, causing excessive bleeding.
The most common bleeding disorder in the world, affecting men and women of all ethnic and racial backgrounds, is von Willebrand’s Disease, and most people suffering from the condition don’t know that they have it. Common symptoms include frequent nosebleeds, easy bruising, gum bleeding and heavy reproductive bleeding. Bleeding after tonsillectomy/adenoidectomy also occurs often.
While there are other clotting conditions that can cause heavy menstrual bleeding, it’s important for you and your daughter to recognize certain warning signs that indicate a need for medical follow-up:
▪ Periods lasting more than seven days.
▪ Flooding or bleeding through pads or tampons in two hours or less for several days of each period.
▪ A history of iron deficiency anemia.
▪ Family history of a documented bleeding disorder.
▪ Personal or family history of excessive bleeding with surgeries or childbirth.
▪ Personal or family history of blood transfusion to manage reproductive bleeding.
▪ Family history of women with early hysterectomy to control reproductive bleeding.
The good news is that while there are many possible explanations for teens experiencing heavy periods, there are also treatments available to manage and underlying bleeding disorder.
In the case of the patient mentioned earlier, she and her relatives were diagnosed with von Willebrand’s Disease. She has been able to manage her periods and easy bruising with Stimate, a nasal spray, and Lysteda, a clot-stabilizing pill. Her periods now last five days. She has resumed her preferred clothing styles and activities, and is back to normal.
If your teen is experiencing heavy menstrual bleeding, schedule an appointment with your pediatrician or primary care physician. Ask for a consultation with a pediatric hematologist. Or call 305-585-5635 to schedule an appointment at the Pediatric Hemophilia Treatment Center.
Joanna Davis, M.D., is a pediatric hematologist at the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.