Heavy Bleeding in Adolescence
Question
My daughter turned 12 on May 6th. Two days later she started her period. She had her second period the first week of June, and now her third began on June 29th, which has been three days so far. Each of the first two periods lasted approximately 6-7 days. For each of these periods, my daughter has absolutely saturated her pads within an hour or less. She began trying tampons during her second period and still was soaking through that as well as the accompanying pads within an hour or two. The pads are totally full and leak through her clothing, onto chairs, and of course all over the middle of her bed. She fainted in school on the second day of her first period. When she was in the nurse’s office she “freshened up” in the bathroom and rested on the cot. I arrived 1/2 hour later and she had a good-sized puddle of blood on the cot, even with a thick pad on. Now, during her third period, it unfortunately began at sleep-away camp this week. My daughter spent an afternoon in the camp nurse’s office because of feeling faint. I picked her up today and between her arrival home today at 3:00 pm and bedtime at 9:30, she soaked through 4 pads and feels very light-headed and weak. I’ve called her pediatrician who wants me to call a GYN next week. As a pre-teen and teen I also had extremely heavy periods, as did my mother as a youth. I was put on birth control pills from age 12-14 which caused moodiness and weight gain.
My questions are:
1) Is the amount of bleeding normal or excessive?—several friends with teenage daughters tell me their daughters never had such a problem.
2) What about the dizzy/faint feeling that lasts for days–could she be anemic, even though she takes a multi vitamin with iron every morning?
3) Are birth control pills the only option–I read something about ibuprofin & naproxin being helpful? I would hate to see my sweet, slim young girl become moody and heavier (as I did) because of birth control meds if there are other alternatives to reduce the bleeding.
4) Is it OK for a young girl to use “super” tampons? The slim and regular don’t help her at all the first few days of her period.
She’s very athletic, but can’t participate in her sports for days on end. This is actually beginning to depress her–she has little energy, feels embarrassed, is afraid to leave the house and was crying this evening for fear that she will once again soak through everything as she sleeps.
I would really appreciate any insight and answers to my questions. Thank you in advance.
Answer
Last Updated: July 10, 2013
Heavy periods in adolescence (or in premenopause) can result from anovulatory cycles. In this type of cycle, the uterine lining builds up because of the presence of the hormone estrogen. However, there is a lack of the hormone progesterone, which normally is present in then last half of the cycle. The progesterone organizes the lining of the uterus and helps it shed in a regular way at the end of the cycle. When there is estrogen “unopposed” by progesterone, very heavy bleeding can result either with monthly cycles or in a more irregular pattern.
A simple treatment is for the young woman to take progesterone in the last half of the cycle. The best form of progesterone for a young woman is usually oral Prometrium 200-300 mg., to be taken at bedtime for 10-12 days starting on day 16 or 18 of the cycle. (Day one is the first day of menses). The periods should improve considerably with this type of therapy. If a young woman has very heavy periods that are infrequent, say three times a year, the Prometrium can be taken for 10 or 12 days every two or three months.
The period will begin normally just after the Prometrium is stopped. If insurance doesn’t cover this, the prescription can be obtained at Costco for a more reaosnable price. The Prometrium can be used for 6-12 months, and then stopped to see if the young woman’s cycles have improved. If not, the Prometrium can be resumed for another 6-12 months and is safe to take for very long periods of time, as it is simply augmenting one’s own natural progesterone. Your daughter will need a good calendar to keep track of her cycles and calculate when she needs to start her medication.
There is a good reason to avoid birth control pills for teenagers. The use of birth control pills in adolescents has been linked to breast cancer. There is a more certain connection between birth control pills and breast cancer when used in teenagers than in older women. The use of bioidentical progesterone has not been associated with breast cancer, unlike artificial progesterone substitutes such as Provera.
It is not unusual for a teenager to have very heavy periods, but it is along a spectrum from mild to severe. Your daughter seems to be at the “severe” end of the spectrum. She definitely can become anemic from heavy periods and needs her blood count checked. The iron present in her multivitamin may not be sufficient, and she may need a bigger dose such as ferrous sulfate 325 mg. 2-3 times daily. In extreme situations, some teens can even need hospitalization, IV’s and transfusions. Occasionally a clotting disorder such as Von Willebrand’s disease can manifest itself with the onset of periods, and in unusual situations a young woman may need further testing by a hematologist. Prescription doses of ibuprofen, naproxen and especially Ponstel help cramps and can help bleeding to some extent, but would not be adequate therapy in the more serious cases such as your daughters.
Rarely, Prometrium may not work adequately over the short term for hemorrhage, although it is the best therapy for abnormal bleeding in the long term. With hemorrhage, high doses of estrogen together with an artificial progesterone substitute can help stop bleeding, and some of the artificial progestins may work better in this situation. One can use Estrace 2 mg. three times daily with Provera 10 mg. three times daily for 7 days, or alternatively Ovral (a stronger birth control pill) three times daily for seven days.
In medicine, the benefits and risks are always weighed, and short term use of artificial hormones in teenagers is much less problematic than long term use.
Mary L. Davenport, M.D.
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