Heavy Menstrual Bleeding in Teens and Preteens

Teens and preteens — and even parents — are often unaware of what a normal period flow is, or that heavy periods can:

• Be a sign of an inherited bleeding disorder, such as von Willebrand disease
• Lead to other health problems, such as anemia

At the University of Chicago Medicine Comer Children’s Hospital, our specialists help patients and families understand when menstrual bleeding is a serious health concern. In our Heavy Menstrual Bleeding Clinic, we provide expert care to effectively manage menorrhagia (heavy menstrual bleeding) and blood disorders in adolescents and young adults up to age 24.

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What is considered a heavy period in teens and preteens?

Menorrhagia, a common health concern in adolescent patients, is excessive menstrual bleeding that interferes with your teen’s physical, social or emotional quality of life.

“Heavy” can be subjective, but our specialists consider the following factors to determine whether your teen has a heavy flow:

• The number of days between periods
• The number of days in the menstrual cycle
• How often the your teen has to change pads, tampons, period panties or menstrual cups/discs due to the menstrual flow rate

However, it is ultimately up to your teen. If they feel like they have a heavy flow, it is worth a conversation with our specialists.

Heavy Menstrual Bleeding Symptoms

Symptoms of heavy menstrual bleeding include:

• Bleeding through a pad or tampon in an hour or less
• Periods that last for more than a week
• Having large blood clots in the menstrual flow

These can also be signs of an inherited or acquired blood disorder. Beyond heavy menstrual blood flow, symptoms of blood disorders include:

• Nose bleeds
• Easy bruising
• Bleeding gums
• Continuous bleeding after surgery (such as wisdom teeth removal)
• Fatigue
• Iron deficiency and/or anemia

If a preteen or teen has these symptoms, our team can help determine the cause and offer solutions.

Heavy Menstrual Bleeding Causes

Common causes of heavy menstrual bleeding in preteens and teens include:

• Hormonal imbalances, which can be caused by endocrine (hormone) issues like polycystic ovary syndrome (PCOS) or thyroid disease
• Inherited blood disorders, like von Willebrand disease, in which the blood doesn’t clot properly
• Infections
• Certain medications, including some types of birth control

In rare cases, other medical issues can cause heavy menstrual bleeding in younger people, including:

• Fibroids, which are benign (noncancerous) growths in the uterus
• Polyps, which are benign growths in the lining of the uterus
• Adenomyosis, which occurs when tissue in the lining of the uterus grows into the wall of the uterus
• Uterine (endometrial) cancer
• Cervical cancer

At Comer Children’s, we use a team-based approach to diagnose the cause of heavy bleeding, so your preteen or teen can begin the appropriate treatment.

Heavy Menstrual Bleeding Risks

If a teen has heavy menstrual bleeding, it’s important to seek expert care. Without treatment, heavy periods can cause an iron deficiency, which can lead to anemia. Anemia is a condition that occurs when there aren’t enough healthy red blood cells to carry oxygen to the body’s tissues.

Heavy menstrual bleeding can also be a sign of underlying medical conditions that require expert treatment.

When to See a Doctor for Heavy Bleeding

If you or your teen is concerned about heavy menstrual flow, we can help. Our team specializes in diagnosing and treating heavy menstrual bleeding in young people.

A teen or preteen should also be evaluated by our specialists if they are experiencing possible signs of an iron deficiency, such as:

• Paleness
• Lightheadedness
• Fainting
• Fatigue
• Weakness
• Craving or eating ice, paper or cardboard

Joint Consultations with Our Pediatric Gynecologist and Pediatric Hematologist

At Comer Children’s, a pediatric/adolescent gynecologist and a pediatric hematologist work together to provide care for young patients with heavy periods and other blood disorder symptoms. This tag-team approach gives you convenient access to two experts in one setting. With both physicians in the exam room at the same time, we determine the best care plan to address a teen’s gynecologic and hematologic concerns.

Here’s what you and your teen can expect during your first visit:

• Our team will ask questions about your teen’s medical history.
• We will conduct a medical exam, which may include a physical or pelvic exam.
• We may order blood tests and a pelvic ultrasound (imaging test) to determine the cause of your teen’s heavy menstrual bleeding.
• Once we have determined the cause, we will develop a care plan for your teen.

Specialized Treatment for Menorrhagia and Blood Disorders in Teens and Preteens

Our team will develop a personalized treatment plan based on your teen’s medical history, diagnosis, symptoms and other important considerations.

Heavy menstrual bleeding treatment may include:

• Hormone therapy to regulate the menstrual cycle and help manage symptoms. If your teen or preteen has a personal or family history of bleeding or clotting disorders, we can suggest options based on their unique clinical picture. Options may include:
  • Birth control pills or patches
  • Injectable progesterone (Depo-Provera)
  • Hormonal implants (intra-uterine devices or etonogestrel implants)
• Iron supplementation to treat iron deficiency or anemia. Options include:
  • Iron pills
  • Intravenous infusion, which delivers iron directly into the bloodstream through an intravenous line
• Tranexamic acid (TXA), an oral medicine that helps control heavy blood flow