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Heavy periods and bleeding disorder evaluation in adolescents

Jennifer P. Kurkowski, MSN, WHNP; Heather M. Soni, MSN, CPNP; and Madison L. Klavan, MSN, WHNP discuss their article in the October issue of Women's Healthcare, A Clinical Journal for NPs: "Heavy periods and bleeding disorder evaluation in adolescents." https://www.npwomenshealthcare.com/he... Transcript My name is Jennifer Krakowski and I'm a women's health nurse practitioner. I'm an assistant professor in the department of obstetrics and gynecology at Baylor College of Medicine in Houston, Texas. I work in the division of pediatric and adolescent gynecology at Texas Children's Hospital. Hello, my name is Madison Claven, and I'm a Women's Health Nurse Practitioner. I work in the Department of Obstetrics and Gynecology at Baylor College of Medicine. I work alongside Jennifer Krakowski in the Division of Pediatric and Adolescent Gynecology at Texas Children's Hospital. Hello, my name is Heather Soni and I'm a pediatric nurse practitioner. I am an instructor in the department of pediatrics at Baylor College of Medicine. And I work in the hemophilia and thrombosis program at Texas Children's Hematology Center. Jennifer Kurkowski: My co-authors and I are medical providers in the Young Women's Bleeding Disorder Clinic at Texas Children's Hospital. We care for adolescents in this clinic with heavy menstrual bleeding who either have a diagnosed bleeding disorder or are being evaluated for one. In this clinic, both gynecology and hematology providers work together to care for these patients. If you care for adolescent patients, you are going to want to read our upcoming article in the journal titled, Heavy Periods and Bleeding Disorder Evaluation in Adolescents. We feel this topic is important because adolescents have a higher incidence of abnormal uterine bleeding. In fact, up to 20% of adolescents with heavy menstrual bleeding have an underlying bleeding disorder. Madison Klavan In this article, we review the pathophysiology, what to include in the initial workup, hematology evaluation including tier testing, hormonal and non-hormonal treatment, as well as management of iron deficiency anemia and psychological aspects. We recommend initiating this workup if the patient meets one or more of the following criteria. One, if they're bleeding more than seven days a month, they're soaking through a pad or tampon in two hours or less with most cycles, or a family history of a bleeding disorder. While the workup is being initiated, treatment is started. Treatment is essential because managing the heavy menses, whether there is an underlying bleeding disorder or not, is key to patient outcomes, such as iron deficiency anemia and quality of life. Heather Soni Some important pieces of the hematology evaluation that we describe in our article includes obtaining a detailed personal and family history of bleeding symptoms and using screening tools like the ISTH bleeding assessment tool or the pictorial blood loss assessment chart or PBAC, which can be helpful to assess the significance of the bleeding symptoms. We also illustrate helpful insights about the laboratory testing and the treatment aspects, for example, obtaining the von Willebrand levels while the patient is on a placebo week from their hormone pills, especially if the patient is on higher doses of estrogen, and the importance of assessing iron status and fully treating deficiency. Jennifer Kurkowski We hope you've enjoyed this short introduction about our upcoming article. We encourage you to look out and read for our article in the upcoming MPWH Journal in October.