Heavy menstrual bleeding in adolescents: incidence, diagnostics, and management practices in primary care

Stella J. Van ‘t Klooster, Anne de Vaan*, Jeanette van Leeuwen, Lynnda Pekel, Nathalie M. van Rijn-van Kortenhof, Eveline T. Engelen, Willie van Greevenbroek, Albert Huisman, Kathelijn Fischer, Roger E.G. Schutgens, Karin P.M. van Galen

*Corresponding author for this work

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Background: Heavy menstrual bleeding (HMB), self-reported by 37% of adolescents, can be the first sign of a bleeding disorder (BD) during adolescence. The Dutch general practitioner (GP) guideline demands laboratory diagnostics and referral for patients at risk for a BD. How often adolescents consult the GP for HMB and which diagnostic and management strategies are used are unknown. Objectives: This study aims to estimate the incidence of HMB in adolescents in primary care and to identify diagnostic and management practices for HMB, considering the HMB GP guideline. Methods: Retrospective analyses of a GP network database containing over 200 Dutch GPs were performed. Adolescents aged 10 to 21 years, with a new diagnosis of HMB between 2010 and 2020, and a 6-month follow-up were eligible. The incidence rate and diagnostic and therapeutic strategy data were extracted. Results: We identified 1879 new diagnoses of HMB in adolescents. The average incidence rate was 7.91 per 1000 person-years. No diagnostic studies were performed in 67%. Laboratory studies were mainly restricted to hemoglobin levels (31%). Full coagulation screening occurred in 1.3%, and ferritin levels in 10%. Medication was prescribed in 65%; mostly hormonal treatment (56%) and/or nonsteroidal antiinflammatory drugs (NSAIDs) (18%). The referral rate was higher after >2 follow-up visits (6.7%) vs after 1 GP visit for HMB (1.6%; Odds ratio: 8.8; 95% CI: 5.1-15), mostly to gynecologists (>85%). Conclusion: According to this GP database study, few adolescents visit their GP with HMB despite its high self-reported incidence. Most adolescents were prescribed hormonal contraception without further diagnostics. Referral was rare and mostly occurred after multiple follow-up visits.

Original languageEnglish
Article number102229
Number of pages8
JournalResearch and practice in thrombosis and haemostasis
Issue number7
Publication statusPublished - Oct 2023


  • adolescent
  • diagnostic tests
  • heavy menstrual bleeding
  • primary health care
  • referral and consultation
  • von Willebrand disease


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