(72) Menstrual Suppression and Management in Adolescents on Anticoagulation

Background: Abnormal uterine bleeding (AUB) is prevalent and under-researched in adolescents on anticoagulants, and it significantly affects health and quality of life. This study examines the impact of anticoagulation use on menstruation in adolescents and evaluates the effectiveness of menstrual suppression/management methods (MS) in addressing AUB.

Methods: This observational cohort study included females aged 14-19 years who initiated anticoagulants between 1/1/2010 and 1/1/2021 and remained on them for at least four months. Structured chart review identified menstrual suppression and anticoagulant usage. Demographic and clinical data as well as hemoglobin levels were collected. Baseline and follow-up hemoglobin levels served as proxies for AUB severity. Statistical analyses included Wilcoxon tests for non-normally distributed continuous variables, and Fishers exact and Chi-square tests for categorical variables.

Results: Out of 125 eligible patients, median age 18, 33.6% (n=42) used menstrual suppression while on anticoagulants. Among these 42 patients, 35.7% used hormonal IUDs, 19.0% used progestin-only pills (POPs), and 19.0% used Depo-Provera. Before starting anticoagulants, 39.2% were anemic (hemoglobin < 11.4 g/dL). Anemia during follow-up was more common among older adolescents, Black adolescents, those on Heparin, and those that were anemic at baseline. Baseline anemia was more prevalent in patients using menstrual suppression compared to those not using it (52.4% vs 32.5%, p=0.03), with no significant difference seen in follow-up anemia (23.8% vs 15.7%, p=0.27).

Conclusions: Adolescent females on anticoagulation may benefit from concurrent menstrual suppression methods to reduce the risk of significant AUB.