(111) Surveying the Prevalence of Heavy Menstrual Bleeding in Adolescents with Mullerian Anomalies

Background: Heavy menstrual bleeding (HMB) is common in young women and associated with disruptions in their academics, extracurricular activities, and social well-being. HMB can also result in iron deficiency anemia and need for transfusion. Mullerian anomaly (MA) is an umbrella term for several specific diagnoses that present with various symptoms, and at times require medical or surgical management. To date there is limited knowledge surrounding various MA subtypes and association with HMB. Researching the prevalence of HMB in patients with Mullerian anomalies is essential because identification can allow providers to be proactive in diagnosing and counseling patients with Mullerian anomalies. The aim of the study is to describe the prevalence of HMB among patients with Mullerian anomalies.

Methods: We conducted a retrospective chart review of patients diagnosed with a MA at a large tertiary children’s organization from 2014-2024. We queried the Electronic Health Record (EHR) for diagnosis of Mullerian anomalies using the following terms: Mullerian anomalies, uterine anomalies, bicornuate uterus, didelphic uterus, uterine septum, unicornuate uterus, and arcuate uterus. We defined HMB as any provider diagnosis of HMB, menorrhagia, or prolonged menstrual bleeding. We collected data on patient race, age at time of diagnosis of MA and HMB, age of menarche, subtype of MA diagnosis, hematologic results, and treatment received for HMB. Imaging data, including modality (ultrasound and MRI) and date imaging was performed, was also collected. We also looked for presence of bleeding disorder evaluation or diagnosis. Exclusion criteria included those of premenarchal status. We performed simple descriptive statistics to calculate the prevalence of HMB in our population. For quality assurance, 15% of the charts were reviewed by two coauthors and all coauthors met to address any discrepancies to ensure standardization of the process. The Children’s Healthcare of Atlanta IRB approved this study on June 6th, 2024.

Results: The initial chart query yielded 316 patients; 59 were excluded due to premenarchal status and 63 were excluded because a Mullerian anomaly diagnosis could not be confirmed. The most common diagnosed MA was bicornuate uterus followed by didelphic uterus. Of the 194 patients included 67 (34.5%) experienced HMB. The most common treatment for HMB was COC. Final results will include comparison to HMB in the general adolescent population and statistical analysis of other variables included.

Conclusions: These findings on HMB prevalence in adolescents with Mullerian anomalies will aid proactive strategies for counseling.