Adolescents Presenting to the Emergency Department with Heavy Menstrual Bleeding

Study Objective: To describe the adolescent population that seeks care in the emergency department (ED) for heavy menstrual bleeding (HMB), and to compare those who are discharged to those who are admitted to the hospital. Design: Retrospective study. Setting: Emergency department and inpatient unit at a national tertiary care hospital from 2006-2018. Participants: Adolescents 11-19 years old with ICD-9 and ICD-10 codes for HMB. Interventions: Chart abstraction for demographic data, symptoms, laboratory tests, outcomes, and treatments. Main Outcome Measure: Adolescents who were admitted were compared to girls who were treated as outpatients. Results: There were 258 adolescents who sought care for HMB in the ED during the study period. A total of 44 patients (17%) were admitted to the hospital, whereas 214 (83%) were discharged. The average age of those admitted was 15 years, compared to 17 years for those discharged (P < .001). In the admitted group, the mean initial hemoglobin (Hgb) was 6.3 g/dL compared to 12.0 g/dL in the discharged group (P < .0001). Only 23% of the discharged patients were released with medications; the remainder did not receive treatment. Anovulation was the etiology of HMB in the majority (56%) of both inpatients and outpatients. Of the 44 adolescents admitted to the hospital for HMB, 12 (27%) had a bleeding disorder (BD) and 32 (73%) did not. Conclusion: The majority of adolescents who presented to the emergency department for HMB were not anemic and did not receive any treatment. Of those admitted, almost one-third had an underlying BD, which is higher than previously reported.