Menometrorrhagia is a common symptom in adolescents. It is idiopathic in most cases. In case of menometrorrhagia, it is necessary to exclude a pregnancy, a disorder of hemostasis, particularly the
von Willebrand disease, as it represents the most common inherited disorder, and more rarely a
chronic disease or an endocrinopathy. History of the bleedings, menstrual blood loss quantification by the Higham score and tolerance of the bleedings (blood pressure) should be evaluated. Laboratory testing includes hCG,
ferritin level, a complete blood count, a prothrombin time, an activated partial
thromboplastin. Management of menometrorrhagia is related to the severity of the blood loss. It associates
antifibrinolytics or
non-steroidal anti-inflammatory agents (
NSAIDS) with hormonal treatments, such as
estrogen-
progestin oral contraceptive pill or cyclic oral
progestins. Primary or functional
dysmenorrhea concerns 40 to 90% of the teenagers and represents a frequent cause of school absenteeism. Management of primary
dysmenorrhea is primarily based on a treatment by
NSAIDS. In case of its inefficacy or if
contraception is needed hormonal treatments, such as
estrogen-
progestin combined pill should be prescribed. It is very important when
pelvic pain is chronic and not soothed by simple medications to look for a secondary
dysmenorrhea, mainly
endometriosis. In such cases, pelvic magnetic resonance imaging should be performed.