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Young Womens Blood Disorders

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We offer a more streamlined and skilled approach to treating excessive menstrual bleeding, a problem that can cause embarrassment, interfere with daily activities and even lead to hospitalization. Previously, younger patients did not have a place to go for care. Older teens and young adults visited multiple offices, and their doctors often lacked the expertise to diagnose those with underlying blood disorders. We changed that for our patients, ages 9 to 21.
 

Why Children's Health?

Our Young Women’s Bleeding Disorders clinic is the only program of its kind in North Texas, and just one of two in the state. It puts top specialists in reproductive health and blood disorders under one roof. It also offers comprehensive care, a strong research component and pediatric gynecology, a field where specialists are scarce. Our team is all female for additional patient comfort and includes:

  • Hematologists: Hematologists specialize in blood diseases. Ours are board-certified and underwent additional, fellowship-based training in the fields most relevant to our program — pediatric hematology/oncology and pediatric hemostasis/thrombosis, the study of bleeding and clotting disorders. Their extra training and experience allows them to make accurate blood disorder diagnoses, a challenging task that can take up to six months. Less specialized hematologists often miss these disorders.
  • Pediatric/adolescent gynecologists: Our gynecologists are board-certified in obstetrics and gynecology. They specialize in treating children, teens and young adults and have years of experience.
  • Pediatrician/adolescent medicine physician: Our pediatrician and adolescent medicine physician is board-certified in family medicine. She completed a fellowship in adolescent medicine, advanced training in issues that particularly affect teens. In addition to helping with treatment plans, she provides counseling for issues tied to excessive bleeding, such as embarrassment and lack of desire to go to school, see friends or participate in activities.
  • Nurse: Our nurse is specially trained to provide advice on the use of birth control (one possible treatment) and the treatment of iron deficiency (a potential side effect of excessive bleeding), including dietary changes.

Conditions We Treat

Excessive menstrual bleeding is fairly common, though the reasons for it vary. The problem can cause patients to miss school or work, limit their daily activities, feel embarrassed and (at times) check into the emergency department if they feel weak. We treat all causes of excessive menstrual bleeding, as well as the side effects:

  • Irregular or heavy periods: It is not uncommon for girls to endure heavy or irregular periods in the first two to three years after hitting puberty. While the problem eventually goes away, we may need to temporarily regulate their monthly menstrual cycles. Being obese or overweight can also trigger excessive bleeding.
  • Von Willebrand disease and other bleeding disorders: Some patients’ excessive bleeding is caused by a bleeding disorder, often inherited from one or both parents. The inherited Von Willebrand disease is the most common and is characterized by a problem with platelets, a type of blood cell that forms clots to stop bleeding. With Von Willebrand, a protein needed for clotting is missing or defective, so the platelets can’t stick together or attach to blood vessel walls. Many other platelet disorders are also inherited, while a few develop after birth (acquired disorders).
  • Iron-deficiency anemia: Iron-deficiency anemia is a side effect of excessive bleeding. Large amounts of iron are lost with the blood, eventually depleting the stores that the body needs to create healthy red blood cells. Fewer red blood cells are made, and those that are have less hemoglobin, the protein that carries oxygen. Anemia can leave you feeling fatigued and weak.
  • Thrombophilia: Some patients with excessive menstrual bleeding also have thrombophilia, a higher tendency to develop blood clots that is either inherited or develops after birth (acquired thrombophilia). It is marked by a higher level of a natural chemical promoting clotting (clotting factor), or by the lack of a balancing chemical keeping clotting in check. Thrombophilia is neither a cause nor a side effect of excessive menstrual bleeding but can interfere with treatment.

Expert Care

Our program brings together a team of experts in the different specialties needed for excessive menstrual bleeding. This ensures timely and efficient care, an accurate diagnosis and the most appropriate therapy. With our range of experienced specialists, we avoid common scenarios faced by patients, including:

  • Finding Care: While younger patients who encounter problems after they start their periods often see their pediatrician first, pediatricians usually do not have enough training in this area to feel comfortable providing treatment. It is hard to find a gynecologist for such young patients, though, because most gynecologists choose not to do the additional training to treat children and teens. Our program conveniently provides the needed depth of expertise.
  • Avoiding misdiagnosis: A patient in our targeted age range may find a doctor but then quickly get treated with birth control pills, without a deeper investigation. This works for many patients, but others can have an underlying blood disorder that goes undiagnosed because a hematologist was not consulted. Such patients feel better for a while but then encounter more serious problems if they undergo surgery or give birth. That is why our specialists in blood disorders and reproductive health work closely together.

Treatment

We offer effective treatments for all causes of excessive menstrual bleeding, as well as the side effects the condition can cause. These include:

  • Contraceptives: Excessive menstrual bleeding is controllable with birth control pills, hormonal implants or intrauterine devices (IUDs), though many parents decide against the latter two options for younger children. Our team offers particular expertise for patients with a tendency to clot (thrombophilia). Many community doctors won’t prescribe birth control if a patient has thrombophilia because clotting is already a possible treatment side effect (albeit an unlikely one). We know which birth control pills come with the lowest risk and are safe to give to patients with thrombophilia.
  • Antifibrinolytic therapy: Some patients with heavy menstrual bleeding have high levels of enzymes (plasminogen activators) in the lining of their uterus (the endometrium). While these enzymes dissolve clots, abnormally high levels can cause problems. We treat this with inhibiting medications called antifibrinolytic agents.
  • Desmopressin acetate and other clotting factors: Von Willebrand’s disease is usually treated with desmopressin acetate, also called DDAVP. This lab-produced version of the natural hormone vasopressin causes cells to release the healthy clotting protein that is otherwise missing or deformed by the disease. It usually comes in a nasal spray. We also use other clotting factors to treat bleeding disorders.
  • Iron treatment: We treat iron-deficiency anemia related to heavy menstrual bleeding with iron pills or drops, as well as dietary changes. Severely depleted patients may get iron from an intravenous (IV) line, while those going to the emergency room often need blood transfusions.
  • Clinical trials: One of our most recent clinical trials seeks a solution for a challenge with birth control treatment. If a patient already has a tendency to clot (thrombophilia), physicians often prescribe a progesterone-only pill, which is more likely to cause water retention and weight gain than a standard pill. Because of these side effects, many teens and young adults don’t stick with their treatment. Our study looks at the effectiveness and safety of giving a third type of pill that reintroduces a low amount of estrogen to avoid water retention and weight gain.