Heavy periods in teens
Irregular periods are common in the first few years. Periods that are very heavy from the start are different, and they are a reason to check for a bleeding disorder.
What is typical for teens
In the first years after a first period, cycles often run 21 to 45 days apart and usually last seven days or less. Needing to change a pad or tampon every one to two hours, bleeding longer than seven days, or missing school because of periods is not typical.
Why bleeding disorders matter
A meaningful share of teens with heavy periods have an inherited bleeding disorder. The most common is von Willebrand disease. Many are never diagnosed because heavy periods are assumed to be normal. Clues include:
- Heavy bleeding since the very first period
- Frequent or long nosebleeds, or bleeding gums
- Easy bruising
- Heavy bleeding after dental work, surgery, or an injury
- A family member with a bleeding disorder or heavy periods
What evaluation usually involves
Expect a blood count and ferritin, a pregnancy test when appropriate, a thyroid test, and blood-clotting tests. Specific von Willebrand testing is often done with a hematologist.
Treatment
Hormonal options, including the pill and the levonorgestrel IUD, are safe and effective for most teens. Tranexamic acid can also help, and so can treating iron deficiency. Teens with a bleeding disorder should avoid NSAIDs such as ibuprofen for bleeding control, and should have a plan for surgery and dental work.
Consent
A parent or guardian needs to consent to telehealth care for patients under 18.
Sources
- American College of Obstetricians and Gynecologists. Committee Opinion No. 785: Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding. Obstet Gynecol. 2019;134(3):e71–e83.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 651: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstet Gynecol. 2015;126(6):e143–e146 (reaffirmed).
- Connell NT, Flood VH, Brignardello-Petersen R, et al. ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease. Blood Adv. 2021;5(1):301–325.