Hypermobility Syndromes in Heavy Menstrual Bleeding

Abstract

Generalized joint hypermobility (GJH) is a common problem in adolescent females with disease manifestations that range from benign and asymptomatic presentations to potentially life-threatening inherited conditions. Of the inherited conditions, hypermobile Ehlers-Danlos syndrome is by far the most common. Despite a diverse genetic basis for the variety of diseases associated with GJH, many of these conditions are associated with an increased risk of bleeding, and many adolescents, particularly those without other associated structural co-morbidities, may have mucosal or abnormal uterine bleeding as a presenting symptom. It is important that primary care and subspecialty services performing evaluations for these symptoms know to consider a diagnosis of GJH and its associated conditions, particularly when another overt bleeding disorder is not apparent, as establishing a diagnosis may not only provide answers to the patients but also an opportunity for early screening and physical interventions aimed at reducing long-term complications of disease. Unfortunately, at the current time, there is very little published data addressing the optimal management of adolescent girls with GJH and abnormal bleeding and even less data related to the management of heavy menstrual bleeding. Moving forward, hematologists and gynecologists should set their sights on closing the knowledge gaps that exist when it comes to the identification and management of heavy menstrual bleeding in girls with GJH.