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 progestins

What 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.