ALBERT

Description: Menorrhagia occurring during adolescence and perimenopause is presumed to be associated with anovulation, and during perimenopause, with uterine pathology, such as subserosal uterine myoma, as well. The frequency of bleeding disorders in women presenting with menorrhagia at the extremes of menstruating age, ie adolescence and perimenopause, are not known. We conducted a study to evaluate the frequency and types of hemostatic defects found in adolescent and perimenopausal age women diagnosed with menorrhagia. 115 women with a physician diagnosis of menorrhagia, including 25 adolescent women, 25 perimenopausal age women, and 65 women between the ages of 20 and 44, underwent comprehensive hemostatic testing for possible bleeding disorders. There were no significant differences between the three age groups in mean hemoglobin, percentage of women with anemia, duration of menses, mean pictorial blood assessment scores, or race. Overall, 48% of women were found to have hemostatic abnormalities. Hemostatic abnormalities among women with menorrhagia Overall ≤ 19 yrs 20–44 yrs ≥ 45 yrs p-value N=115 N=25 N=65 N=25 *Platelet aggregation, Von Willebrand factor, and/or coagulation factor Platelet Aggregation 44% 44% 48% 32% 0.48 Von Willebrand Factor 7% 4% 8% 8% 0.78 Coagulation Factor 5% 8% 6% 0% 0.34 Any Abnormality* 48% 48% 54% 32% 0.32 Adolescents and perimenopausal age women diagnosed with menorrhagia were as likely as women presenting between age 20 to 44 to have underlying hemostatic defects. Among the adolescents, neither age at presentation nor time from menarche were predictive of having a bleeding disorder. The platelet aggregation defects observed were similar among the three age groups with the exception of ADP induced platelet aggregation defects which were seen significantly more frequently in adolescents compared to older women (p≤ 0.01). Ristocetin and epinephrine induced platelet aggregation defects were the most common aggregation defects in women 20 years and older and ADP induced platelet aggregation defects were the most common among adolescents. There were no significant differences in platelet ATP release abnormalities between the three age groups. Our results demonstrate that a high proportion of adolescents and perimenopausal age women presenting with menorrhagia have bleeding disorders. These results suggest that menorrhagia in the adolescent, even if presenting soon after onset of menarche, and in perimenopausal age women, even if fibroids are present, may warrant hemostatic evaluation. Further age-specific studies evaluating treatment benefits and outcomes in women with menorrhagia diagnosed with bleeding disorders are warranted.