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Heavy Menstrual Bleeding in Adolescents
No specific investigations are required FBE, ferritin and coagulation screen if heavy menstrual bleeding
Education and Resources Many adolescents with intellectual disabilities can cope with menses given the right tools:
Pain and Behavioural Changes
Heavy Menstrual Bleeding Heavy menstrual bleeding can cause distress. Tranexamic Acid is safe to use in combination with NSAIDs and with both combined and Progestogen-only hormonal methods
Hormonal There are many non-contraceptive benefits to hormonal suppression, including a reduction in seizures and other cyclical symptoms that flare with menses
Consider:
Oral Contraceptive Pill (OCP)
Progestogen-only
Drug Class
Considerations
Contraception
Dose
NSAIDs
Reduces menstrual pain, up to 30% reduction in blood loss, may reduce nausea, vomiting, diarrhoea
No
Ibuprofen 400 mg tds or Mefenamic acid 500 mg tds
Tranexamic acid
45-60% reduction in blood loss, can reduce pain
Tranexamic acid 1g tds on days of heavy bleeding
Continuous OCP
Marked reduction in menstrual pain and blood loss, may eliminate cyclic seizures and other symptoms
Yes
Levonorgestrel 150 mcg/ethinyl estradiol 30 mcg (Levlen®) daily (active pills only)
Oral Progestogen
Reduction in menstrual blood loss and pain, may eliminate cyclic symptoms
Norethisterone (Primolut N®) starting at 5 mg BD, continuously
IM Progestogen
Markedly reduces menstrual pain and blood loss, may eliminate cyclic seizures and other symptoms
Subdermal Progestogen
Highly effective contraceptive but erratic pattern of bleeding is common. Minor surgical procedure
Etonogestrel implant (Implanon®), 3 yearly
Progestogen-releasing intrauterine device
97-98% reduction in blood loss at 12 months, reduces menstrual pain. Highly effective contraceptive. Requires general anaesthetic
Levonorgestrel intrauterine device (Mirena®), 5 yearly
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Last updated April 2020