Dr. Tyson Urges Pediatricians to Assess Adolescent Menstrual Concerns

Tyson emphasized that identifying underlying bleeding disorders and severe dysmenorrhea early can prevent catastrophic health events. Tyson noted, I think that’s such a great asset to give a young person is to identify this bleeding disorder early in life to prevent blood transfusions and sort of catastrophic events later, she said.

Clinicians Assess Adolescent Bleeding Disorders and Anemia Symptoms

Clinicians evaluating adolescent patients should assess for fatigue and symptoms suggestive of anemia, alongside a detailed history of excessive bleeding during dental procedures or wisdom tooth extractions. Tyson noted that identifying bleeding disorders during adolescence serves as a vital asset to prevent blood transfusions later in life. Initial diagnostic evaluations often include a complete blood count, ferritin, thyroid-stimulating hormone, follicle-stimulating hormone, and pregnancy or androgen tests when indicated. For heavy menstrual bleeding, providers should consider coagulation studies and von Willebrand panels.

Identifying Red Flags in Menstrual Cycles

Normalizing significant menstrual pain can delay diagnoses of conditions such as endometriosis. Tyson cautioned against the cultural tendency to dismiss period pain, noting that pain severe from the very first menstrual period is atypical. I think we all dismiss sort of period pain as sort of a coping, like yeah, yeah, grin and bear it, Tyson said. But really, paying attention to these kinds of red flags is key. Progressively worsening pain also raises concern, particularly when paired with heavy bleeding or a family history of endometriosis.

Primary Care Follow-Up and Specialty Referral Criteria

Pediatricians are encouraged to routinely ask adolescents about their menstrual cycles during any visit, even when menstruation is not the reason for the visit, with Tyson stating, I think all pediatricians should be asking girls about their periods. I think that’s step one, she added. Menstrual tracking and basic laboratory testing can often begin in primary care. Patients who fail to improve after three to six months of initial treatment warrant further evaluation or specialty referral, as Tyson explained: We don’t just give them that and send them away. So it’s really important to bring them back in three to six months, see how they’re using their medicine, see how the pain is resolving, and really, if it’s not, then that’s time to move on. Additional indicators for specialist referral include the absence of menarche by age 15, failure to menstruate within three years of breast development, cycles shorter than 21 days or longer than 45 days, a three-month gap between periods, or cycles that become irregular after previously being regular. Other reasons for specialty care encompass anemia, suspected bleeding disorders, abnormal androgen testing, persistent dysmenorrhea, complex medical conditions, and when patients or families want additional counseling about menstrual management or hormonal treatment.

We don’t really think there are any bad referrals or consults.

N. Tyson