Differences in bleeding phenotype and provider interventions in postmenarchal adolescents when compared to adult women with bleeding disorders and heavy menstrual bleeding

IntroductionDue to lack of patient/health care provider awareness causing delayed diagnosis, the bleeding phenotype and provider interventions in adolescents with heavy menstrual bleeding (HMB) and bleeding disorders (BD) may be different when compared to adults. AimThe aim of this study was to compare/characterize bleeding phenotype and provider interventions in postmenarchal adolescents<18years and premenopausal adults 18years with HMB and BD. MethodsPatient demographics, BD, and provider interventions/therapy details for HMB were compared between both age groups enrolled in the Centers for Disease Control and Prevention (CDC) Female Universal Data Collection (UDC) surveillance project in United States hemophilia treatment centres. Cross-sectional descriptive analyses including frequency distributions, summary statistics, bivariate and logistic regression analyses were performed. ResultsOf 269 females (79 adolescents; median age 16years, interquartile range (IQR)=2; 190 adults; median age 27years, IQR=13) evaluated, BD distribution was similar in both groups. Compared to adolescents, adults more often had family history of bleeding (Adjusted odds ratios [AOR]=2.6, 1.3-5.6), delay in diagnosis (AOR=2.5, 1.2-4.9), bleeding with dental procedures (AOR=2.0, 1.0-4.0), gastrointestinal bleeding (AOR=4.6, 1.0-21.9), anaemia (AOR=2.7, 1.4-5.2), utilized desmopressin less often (AOR=0.4, 0.2-0.8) and underwent gynaecologic procedure/surgery more frequently (AOR=5.9, 1.3-27.3). ConclusionBleeding phenotypes of adolescents and adults with HMB and BD were different with more frequent bleeding complications, anaemia, gynaecologic procedures/surgeries, less desmopressin use and more delay in diagnosing BD in adults. Longitudinal studies are needed to determine whether improved patient/provider awareness and education will translate to early diagnosis and timely management of BD/HMB in adolescents that may prevent/reduce future haematologic/gynaecologic complications.