Antifibrinolytics First Line for Teen Menorrhagia.

TORONTO -- Physicians should consider antifibrinolytic therapy plus standard estrogen therapy as first-line treatment for acute menorrhagia in adolescents, Canadian experts said.

"We have to be more aggressive in treating these patients. This is now standard protocol for us. We start both the hormones and the antifibrinolytics as soon as we admit them, and it reduces bleeding significantly," said Dr. Nathalie Fleming, a fellow in pediatric and adolescent ob.gyn. at Sainte-Justine Hospital in Montreal.

"We need a formal study to determine the advantage of this protocol in terms of decreasing the need for transfusions and D&Cs, but our own experience in treating acute menorrhagia with this combination has been excellent," Dr. Diane Francoeur, also of the hospital, said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

Antifibrinolytics, which prevent clot dissolution, have been used extensively in the fields of hematology and oncology. Until recently however, their use specifically for menorrhagia has been confined to Europe.

"It's something most U.S. ob.gyns. know very little about, but they have an excellent, well-documented safety and efficacy profile," said Dr. Judith Simms-Cenden, a Florida ob.gyn. who tried the approach on two patients after consulting with the Montreal group.

"I had tried everything else on these patients and they were not responding, but I noticed results almost immediately with antifibrinolytic therapy," said Dr. Simms-Cenden of the University of Florida in Gainesville.

Ten to 15% of all women experience dysfunctional uterine bleeding (DUB), but the incidence is much higher in adolescents, ranging from 55% to 82% in the first 2 years after menarche and decreasing to about 20% in the first 4 years.