Feature Article

The teenager with heavy menses

Joelle Dennie, Sonia Grover



Heavy irregular menses in adolescence is a common problem that can have a significant impact on a teenager’s quality of life. GPs, paediatricians and gynaecologists are well placed to diagnose these disorders and provide treatment, education and follow up.

Key Points

  • The most common cause of heavy menses in adolescents is anovulation due to an immature hypothalamic pituitary ovarian axis.
  • Bleeding disorders such as thrombocytopenia, platelet dysfunction and von Willebrand disease should be considered in a young woman who presents with menorrhagia, especially with her very first period.
  • A pelvic examination is not always required to manage heavy menses in adolescents.
  • Nonhormonal treatments such as NSAIDs and tranexamic acid can be very effective for adolescents with menorrhagia.
  • Hormonal management (e.g. combined oral contraceptive pill or oral progestins) may be a good long-term option for adolescents with heavy menses.