Data show ‘several gaps’ in care of adolescents with heavy menstrual bleeding
Click Here to Manage Email Alerts
Key takeaways:
- Less than half of adolescents received a hematologic workup.
- Black adolescents received less counseling and prescriptions for hormonal therapy compared with white adolescents.
Researchers identified various gaps in evaluation and management of heavy menstrual bleeding among a cohort of adolescents, according to study results presented at ASH Annual Meeting and Exposition.
“These findings underscore the need for more comprehensive and standardized evaluation protocols to ensure effective management of heavy menstrual bleeding in adolescents,” researchers concluded.
Essential assessment
“Heavy menstrual bleeding is a prevalent issue in adolescents, with significant adverse impacts on physical, mental and social health,” Asavari Rajpurkar, MD, researcher in the department of general surgery at University of Michigan, and colleagues wrote. “While the differential diagnosis for heavy menstrual bleeding is broad, studies estimate that up to 62% of adolescents may have an underlying bleeding disorder.
“Primary care providers are frequently the first to evaluate adolescents’ heavy menstrual bleeding concerns,” they added. “Thus, it is essential to understand current primary care practices for assessing heavy menstrual bleeding to improve early recognition, evaluation and management.”
Researchers sought to describe physicians’ evaluation, treatment and management practices for the initial assessment of heavy menstrual bleeding among 359 adolescents aged 9 years to 16 years between January 2017 and June 2019 who presented to a pediatrician or family medicine physician for initial evaluation of heavy menstrual bleeding. They identified patients by ICD-10 codes and confirmed through chart review.
Hematologic workup, hormonal therapy discussion and treatment, and referrals to a specialist served as primary outcome measures. Secondary outcome measures included assessment of family history, evaluation of hematologic symptoms and quantification of heavy menstrual bleeding.
Investigators performed Chi-squared tests to conduct subgroup analyses to identify whether primary outcomes differed by race and insurance status.
Physician work-up
Results showed that only 41.2% of adolescents received a hematologic workup — complete blood count (41.2%), iron testing (14.2%) and von Willebrand testing (10.6%).
Overall, 74.7% of patients underwent discussions about hormonal therapy treatment and 47.1% received prescriptions for hormonal therapies. Of note, researchers observed low referral rates to hematology (3.3%) and gynecology specialists (10.6%).
Most physicians (74.7%) inquired about heavy menstrual bleeding severity, including duration of heavy bleeding (63.2%), frequency of menstrual product changes (34%) and number of menstrual products used daily (18.7%).
However, most adolescents did not receive questioning about family history of bleeding symptoms (79.7%), bleeding disorders (80.5%), the presence of large blood clots (84.4%), nosebleeds (93%), abnormal bruising (89.7%), oral bleeding (92.8%) or fatigue (83.3%).
Results of subgroup analysis showed that Black adolescents received less counseling (P < .01) and prescriptions for hormonal therapy (P = .03) compared with white adolescents. Researchers additionally observed a lower likelihood for receipt of hormonal therapy treatment among adolescents with Medicaid compared with those with private insurance (P = .02). Conversely, results showed a higher likelihood for hematologic testing among Black adolescents (P = .03) and those with Medicaid (P = .045) compared with white or privately insured adolescents.
“Our study revealed several gaps in the initial evaluation and management of adolescents with heavy menstrual bleeding,” Rajpurkar and colleagues wrote.
“Given the prevalence of iron deficiency and underlying bleeding disorders in this population, lack of evaluation likely results in delays in diagnosis and appropriate care,” they added.
Collapse
Rajpurkar A, et al. Abstract 5021. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2024; San Diego.
Read more about
Click Here to Manage Email Alerts