Helping your teen with abnormal bleeding

Dear doctor,
My teenage girl is experiencing irregular, heavy and painful bleeding. It’s now about 3 years since she started having periods. Does she require any treatment, or should we just wait and see?

The encounter you describe is not unusual, and occurs quite often. You may well have been at the brink of disaster, and the gynecologist you mention aptly came to your aid. It’s good all ended well, and you are alive and kicking. But I can sense your frustration at not being able to express your gratitude at an opportune moment.

Teenage girls are especially vulnerable to irregular bleeding, which sometimes can be heavy and painful. It’s mostly blamed on the transitional immaturity of the reproductive system. Teenagers can find this distressing, as it can interfere with their schooling and other social activities. Luckily for most, it’s just a transient period in their reproductive life. Spontaneous resolution tends to be the norm.

The transition into puberty requires a lot of education. This is the only way teenage girls will know what to expect, and how to react. If your teen is well prepared about having periods, and already versed with sanitary precautions, they are more likely to cope with their bleeding patterns. If they are however ignorant of the events linked to puberty, the inevitable bodily changes will leave them more confused and distressed.

Parents have the initial responsibility to judge if their teenagers’ bleeding patterns are abnormal. It may initially be unclear to your daughter about how much bleeding to expect. Having a chat with them will help you make a judgment. Changing several soaked pads in a day is undoubtedly heavy, and bleeding well over a week is certainly prolonged. Irregularity may mean several months without getting a period, but for some the bleeding may be too frequent, occurring unexpectedly in between the month. Pain will vary, but its intensity can be judged by the need for more potent painkillers.

Once you make out that your teenager’s bleeding pattern is abnormal, please arrange a gynecological review. Waiting for spontaneous resolution whilst your daughter is struggling to cope is no good. If they bleed too much, they could become anemic. If in too much pain, they will be unable to concentrate with their day to day activities. All that is needed is a basic assessment, there’s hardly any requirement for intrusive examinations or extensive testing. But a minority may require some blood tests and pelvic imaging. Most will end up with a simple diagnosis, with no longterm reproductive implications.

Heavy bleeding can easily be controlled with tablets, with the addition of iron boosters if the girl was already anemic. If bleeding is very irregular and too frequent, hormonal treatment will likely be required. Some parents will worry about the use of hormones, but they are safe and only need to be used for a short period. There are lots of potent painkillers to choose from, or a combination if required. Those already on hormonal treatment will easily notice an improvement of their pain though. It’s very rare for teenagers and adolescents to require any surgical interventions. But it can happen with uncommon diagnoses.