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How Puberty Can Affect Girls With a Bleeding Disorder

Sometime in the middle of puberty, girls usually get their first menstrual period. Getting your first period is a physical milestone and a sign of becoming a woman; but it can also be confusing and scary, particularly if you have heavy menstrual bleeding (called menorrhagia) due to a bleeding disorder like von Willebrand disease (VWD).

Sometimes women don't even know they have a bleeding disorder until they get their periods and they're heavy or abnormal.

If they're not diagnosed and treated, bleeding disorders can be dangerous. They can cause problems if you ever need surgery, a dental procedure, have a baby, or get into an accident. But knowing you have a bleeding disorder can help you and your health care provider prevent problems.

Here are some signs and symptoms that may point to a bleeding disorder:

  • Heavy menstrual periods.
    • Bleeding for more than 7 days, from the time it begins until it stops.
    • Flooding or gushing of blood, limiting daily activities, such as chores, exercise, or social activities.
    • Passing clots that are bigger than a quarter.
    • Changing tampon and/or pad every 2 hours or less on heaviest day.
  • Low levels of iron in the blood.
  • Anemia.
  • Bleeding symptoms and someone in the family has a bleeding disorder, such as von Willebrand Disease (VWD), or a clotting factor deficiency, such as hemophilia.
  • Heavy bleeding from dental surgery, other surgery, or childbirth and/or other bleeding symptoms such as:
    • Frequent prolonged nosebleeds (more than 10 minutes).
    • Prolonged bleeding from cuts (more than 5 minutes).
    • Easy bruising (weekly, raised and larger than a quarter).

If you have one or more of these signs or symptoms, speak with your parents, your doctor, or other health care professional.

Teenaged girls with heavy periods may be afraid to participate in social activities and may feel they're being excluded. Managing a heavy period can be extremely stressful because you worry about cramps, bloating, and moodiness. Many girls are afraid of soiling clothes or bed sheets. Periods also interfere with physical and sexual activities. Speaking openly about menstruation can be uncomfortable for parents and children, but these conversations can help you feel independent and confident. Remember, menorrhagia can be managed!

Here are some helpful tips:

  • Check out your local hemophilia chapter or Hemophilia Treatment Center (HTC) to learn about special programs for girls with bleeding disorders. Some chapters offer female-only events where you can meet other girls with bleeding disorders, learn more about your condition, and get advice on how to deal with heavy periods.
  • Talk with your doctor or parent about menstruation. Ask:
    • What is considered normal menstrual bleeding?
    • How many pads/tampons are normally used?
    • How many days does a normal period last?
    • How much blood flow should you expect?
    • Discuss the different treatment options for heavy menstrual bleeding including combined oral contraceptives, desmopressin (DDAVP) injection or nasal spray, antifibrinolytic drugs, and factor replacement therapy.
For more information, go to What's a Normal Period?
  • Discuss any fears or anxieties you may have if you've grown up watching relatives deal with heavy bleeding.
    • Ask your family members about their experiences.
    • Ask how they've coped with their bleeding disorder.
  • Check out the many different feminine hygiene products. There are a lot to choose from, including pads, tampons, and menstrual cups. Panty liners, some of which are designed for light bladder leaks, are ideal for heavy periods, especially when used with a super-absorbent tampon. They're very discreet and come in a range of absorbencies and sizes.
  • Request an unrestricted bathroom pass from your school nurse so you can change your tampon/pad frequently throughout the school day.
  • Change tampons regularly.
  • Keep a record of the number of pads or tampons used. This gives your doctor an idea of how much blood you're losing.
  • Talk to your doctor about what to do to relieve cramps, which can range from mild discomfort to pain.
    • Don't take aspirin or ibuprofen, because they interfere with clotting.
    • Try a warm bath or placing a hot water bottle or heating pad on your abdomen to help relieve cramps.
  • Exercise, which can help relieve painful cramps. Aerobic exercise releases beta-endorphins, the body's own natural pain relievers. Engage in an activity that raises the heart rate, such as brisk walking, swimming, or biking. The activity should last at least 30 minutes and be done at least three times a week.
Try not to let your period get in the way of being active and participating in sports.

Body Image and Self-Esteem

Feeling good about yourself or having positive self-esteem is all about how much you value yourself, and the pride you feel in your accomplishments. Sometimes self-esteem is connected to how you think you look, how well you do in school, or what kind of friend or family member you are.

Some kids struggle with their self-esteem when they begin puberty—the time when a person's body begins to grow and change in different ways. Some kids feel self-conscious about these changes and compare themselves to others. As a person with a bleeding disorder, you may be self-conscious about bruises, needle marks, swollen joints, or using crutches. Recognize that your body is your own, no matter what shape, size, or color it is.

You don't have to have a great body to have a great body image.

Having a healthy attitude helps you develop good friendships, grow more independent from your parents, and challenges you physically and mentally. Finding ways to explore these parts of yourself can help boost your self-esteem.