About 40% of adolescents and 15% of adults with heavy menstrual bleeding who were seen in specialty care had underlying bleeding disorders.

Heavy menstrual bleeding – defined as excessive bleeding that affects quality of life – reportedly affects as many as 50% of women during their lifetimes. To understand its underlying causes, researchers performed a meta-analysis of 53 studies – 45 conducted in secondary or tertiary care institutions and eight conducted in community settings.

Key results were as follows:

• causes of heavy menstrual bleeding varied by age; structural disorders appeared to account for nearly 40% of adult cases (although data on these disorders were limited)
• bleeding disorders were highly ­prevalent, accounting for 30% of all cases (16% in adults and 39% in adolescents)
• von Willebrand disease and platelet function disorders were present in 8% and 9% of all cases, respectively
• thyroid dysfunction was identified in 3% of cases overall (16% in adults and 1% in adolescents)
• polycystic ovary syndrome (PCOS) was present in 8% of cases, with no difference in prevalence between age groups.

Comment: Evaluation of heavy menstrual bleeding, a common concern in primary care, should be guided by a thorough history. Management generally focuses on quality-of-life issues; effective options include hormonal treatments, tranexamic acid and NSAIDs. However, NSAIDs are best avoided in patients with bleeding disorders – an important consideration, especially for adolescents who prefer nonhormonal options. When referring patients for gynaecology input, I generally order a pelvic ultrasound; additional testing for bleeding disorders can be considered for selected patients, depending on age, presence or absence of structural causes, and personal or family history of bleeding.

Marie Claire O’Dwyer, MB BCh BAO, MPH, Clinical Assistant Professor in Family Medicine, University of Michigan Medical School, Ann Arbor, USA.

Comishen KJ, et al. Etiology and diagnosis of heavy menstrual bleeding among adolescent and adult patients: a systematic review and meta-analysis of the literature. J Thromb Haemost 2025; 23: 863-876.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Women’s Health, Hospital Medicine.