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Heavy or prolonged menstrual bleeding is a common concern for many adolescents and can sometimes signal an underlying bleeding disorder. This condition, known as heavy menstrual bleeding (HMB), affects 27-37% of women and teenage girls, making it a leading reason for seeking medical help in the UK. In fact, as many as 37% of teenage girls report dealing with HMB, highlighting just how widespread this issue is in this age group.
How Can You Tell If Your Bleeding is Heavy?
You might wonder how to know if your menstrual bleeding is heavier than normal. If you frequently soak through pads or tampons every couple of hours, need to use both pads and tampons together, or wake up to blood-soaked bed sheets at night, it's a sign that your bleeding may be heavier than expected.
What is Heavy Menstrual Bleeding?
According to the International Federation of Gynaecology and Obstetrics (FIGO), Heavy Menstrual Bleeding (HMB) is defined as “excessive menstrual blood loss that interferes with a woman’s normal physical, emotional, social, and material quality of life.” It may occur on its own or alongside other symptoms, affecting both the flow and the duration of menstruation. HMB is particularly common during the menarcheal period (the onset of menstruation) and can be distressing for both adolescents and their families. It can impact a girl's quality of life, leading to poor participation in school, sports, and social activities. Despite its prevalence, only about 6% of women with HMB seek medical help due to unsatisfactory support from healthcare providers.
What Causes Heavy Menstrual Bleeding?
HMB can occur due to hormonal imbalances, particularly involving progesterone deficiency and suboptimal oestrogen levels, which can trigger intermittent heavy bleeding. A normal menstrual cycle typically lasts about 28 days (±5 days), with an average flow of 4 days (±2 days) and normal blood loss of 30 mL per cycle. However, for those with HMB, blood loss can exceed 60-70 mL, causing potential health complications.
Seeking Help: Why It’s Important
If you suspect you have HMB, it's essential to consult a gynaecologist to manage symptoms and prevent complications such as iron deficiency ( anaemia). Proper management of HMB aims to:
- Stop excessive bleeding
- Restore adequate oestrogen levels and synchronise the endometrium (the uterine lining)
- Replenish iron levels
- Prevent further health issues
Investigations and Diagnosis
For adolescents experiencing HMB, the first steps in diagnosis should include:
- A full blood count
- Ferritin levels (to check for iron deficiency)
- Coagulation screening, which tests for clotting or bleeding disorders
- A urine pregnancy test (if sexually active)
Unfortunately, many adolescents do not seek medical help for HMB, even though it is a common and disruptive issue. Research shows that most teens are simply prescribed hormonal contraception without further investigation, and referrals for more specialised care are rare, often only occurring after repeated doctor visits.
A Need for Greater Awareness and Support
While heavy menstrual bleeding is part of the normal maturation process of hypothalamic-pituitary-ovarian axis (the complex system of hormones and feedback loops that controls female reproduction and the menstrual cycle) for many adolescents, it can severely impact their daily lives. Schools and families must work to spread awareness of HMB and provide supportive environments for teens dealing with this condition. Additionally, the healthcare system must offer more compassionate and thorough care to those affected.
Given that HMB can significantly reduce the quality of life, impair social and school activities, and cause health concerns like anaemia, there is a pressing need for more research and better guidance to support those dealing with this often-overlooked issue.
Resource:
Bennett AR, Gray SH. What to do when she’s bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents. Curr Opin Pediatr. 2014
National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management. January 2017
