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May 15, 2005

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Question from Lancaster, California, USA:

My daughter is going to be 14 years old in July. She started her menses at the age of 11. At first, her periods were very inconsistent, which I know to be the norm, but, when she turned 12 years old, they became more stable, approximately every 21 days. Her periods always last at least seven days and sometimes up to 10 days. She usually has severe cramping for the first two to three days. In the past four to six months, she has been bleeding quite a bit of clotted blood. I became concerned when she became scared so we had an appointment with her general pediatrician. My daughter is not sexually active, so she did not have an examination with a speculum, but she did have an ultrasound. Her doctor said that she didn't see any problem, and that she shouldn't worry. Well, we are still concerned. The clots have become larger, about the size of a ping pong ball. Her blood sugars vary between 150 to 210 mg/dl [8.3 and 11.7 mmol/L] during her menses. We are wondering if her diabetes has anything to do with her bleeding in this manner?

Answer:

I don’t think her excessive bleeding is related to her diabetes. I assume her thyroid has been checked and is normal and that the doctor has checked to make sure she isn’t anemic or iron deficient from her excessive bleeding. If her thyroid function is normal, a 12 day course of progesterone might help to normalize her bleeding. 0ften, gynecologists will recommend several months of oral contraceptives, but I usually prefer to start with just a short course of progesterone if birth control isn’t necessary as this will affect the blood sugars less, though it may temporarily increase the insulin requirements. If the bleeding becomes continuous, then birth control pills might be necessary. If this doesn’t help, it might be worthwhile to see a pediatric hematologist to make sure she doesn’t have a mild bleeding disorder interfering with normal clotting.

TGL