18 - Menstrual Concerns in the Adoelscent

We walk through a clear roadmap for evaluating heavy menstrual bleeding in teens, from what counts as normal to when labs and treatment should start. A case of a 15-year-old with 10-day periods and nosebleeds anchors a practical workup and evidence-based care plan.• Normal adolescent cycle ranges and red flags for heavy bleeding• Definitions that guide when to test and treat• Key causes in teens: anovulation and coagulopathy• Focused history and exam without routine pelvic exams• Labs that matter: pregnancy, ferritin, thyroid, coagulation, von Willebrand• When imaging helps and when it delays care• Iron repletion strategies and when to use IV iron• Hormonal vs nonhormonal therapy, adherence, and expectations• Acute management thresholds, IV estrogen, and layering therapy• Long-term options including levonorgestrel IUD and progestinsWhat is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content.