12 year old's bleeding

[lori__0]

  My 12 year old daughter started her first period on January 1st, 1999.  It is now March 3rd and she is still bleeding.  She is currently taking birth control pills and has been since January 25th, but still saturates a pad every hour or two depending on her activity level.  Her ultrasound is normal, and all her blood tests are normal.  She is not anemic because of the mega-doses of iron she ingests daily.  She has been tested for a bleeding disorder, but all has come back normal.  The hematologist states that she expected this because of the high doses of hormones she is taking.  There is no history of bleeding disorders in the family but she does have the little pinpoint red dots.  All the doctors are searching for an answer, but to no avail.  In the meantime, my daughter is moody, lethargic, and depressed.  I am just plain worried.  Her entrance into womanhood had been a nightmare, To say the least.  What do I do next?

[hfhsmdrcs]

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Dear Lori:
When a girl begins to menstruate, she ususally does not ovulate and her first periods can be long and heavy.
When a first menstrual period is very heavy and long, requiring treatment for anemia, there is at least a 1 in 2 chance that the patient has a bleeding disorder, This information comes from studies done by Ann Classens and Carol Cowell, Toronto Hospital for Sick Children, in the early 1980s and has been replicated by others. Hormones will mask some disorders such as  Von Willebrands disease, a variation on factor eight (factor VIII) deficiency. The most common problem is a platelet disorder, usually idiopathic thrombocytopenia purpura (ITP).
A second consideration is thyroid disorder: low thyroid function will also contribute to peculiar bleeding.
Pathology within the uterus is very unlikely with a normal ultrasound study.
Medical therapies besides birth control pills include intravenous premarin; progestin (Provera, Megace); Amicar (epsilon amino acaproic acid) and tranexamic acid; gonadotropin releasing hormone agonist (GnRHa); danocrine.
Consultation with a pediatric/adolescent gynecologist is first choice; a reproductive endocrinologist is second choice. If your physician is not aware of these specialists, the American Society for Reproductive Medicine, ASRM.org, Birmingham Alabama can be helpful.
Keywords: first period heavy bleeding, menorrhagia, dysfunctional bleeding
This information is proivded for educaton purposes and is not a medical consultation. If you hjave specific questions, please contact your physician.