Explanation and reassurance may be all that is required. Medical treatment will depend on the severity of the problem in combination with patient preference or that of the parents for the younger adolescent. The commonest reason for heavy and irregular periods in teenage menstrual cycles is anovulation (eggs are not being released). Typically the endometrium becomes particularly thickened before the period as there has been no progesterone to counter the oestrogen ( style="> style="font-size: 11pt; color:#CCFFFF">Q 24.17). Progestogen therapy (24.17B) is likely to prove beneficial. In adolescence, as the heavy periods are usually related to anovulation, the progestogen can be taken from about the 16th day of the cycle for ten or eleven days. A period can be expected two or three days later. If this regimen does not suffice the progestogen can be taken from earlier in the cycle ( style="font-size: 11pt; color:#CCFFFF">Q 24.17).
The combined oral contraceptive pill is generally the most successful hormone therapy although some parents may have understandable reservations about their daughter starting this even for menstrual control. When sexual activity has begun, the combined oral contraceptive pill may be the preferred choice. If there is reluctance to commence hormonal treatment, tranexamic acid (Q 24.17C style="font-size:11.0pt; ) and mefenamic acid (,, Q 24.17D) may be effective. Tranexamic acid is taken during heavy period days and will reduce the flow. Mefenamic acid reduces the flow and is also beneficial when periods are painful (dysmenorrhoea). It has been estimated that one adolescent in six will have significant dysmenorrhoea. Occasionally, bleeding may be extremely heavy warranting hospital admission.
