STUDY OBJECTIVE: Body image concerns may influence contraceptive choices of adolescents and young adults (AYAs) with eating disorders (EDOs). We aimed to compare long-acting reversible contraceptive (LARC) choices and co...STUDY OBJECTIVE: Body image concerns may influence contraceptive choices of adolescents and young adults (AYAs) with eating disorders (EDOs). We aimed to compare long-acting reversible contraceptive (LARC) choices and continuation rates for AYAs with and without EDOs. METHODS: We used data on LARC insertions from 2017 to 2021 from four US adolescent medicine practices measuring demographics, menstrual history, reason for LARC device, follow-up, and continuation. Additional record search identified participants with EDOs. We examined associations of EDOs and choice of device using adjusted logistic regression and 1-year discontinuation using Cox proportional hazards survival analysis. RESULTS: The cohort included 2,346 AYAs; 80 (3%) with EDO; 32% White; 29% Hispanic, 15% Black. Mean age at LARC insertion 18.7 ± 2.4 years (range 12-25). Participants with EDO vs. without had higher odds of choosing intrauterine devices (IUD) over implants (OR = 2.18; 95% CI: 1.31, 3.61; p = .003). One-year LARC continuation rates were 77% overall and similar for those with and without EDOs. AYAs with EDOs vs without had similar likelihood of LARC device removal within 1 year. Participants identifying as Black non-Hispanic (OR = 0.34;95% CI: 0.26, 0.45, p < .001) and Hispanic (OR = 0.34; 95% CI: 0.26, 0.45, p < .001) vs White non-Hispanic had lower odds of choosing IUDs over implants. Black non-Hispanic AYAs had higher likelihood than White non-Hispanics for LARC removal within 1-year (HR = 1.58; 95% CI: 1.11, 2.25; p = .01). CONCLUSIONS: AYAs with EDOs compared to those without EDOs are more likely to choose IUDs over implants and they have similar high 1-year LARC continuation rates . AYAs of non-White race/ethnicities independent of EDO diagnosis are less likely to choose IUDs.
STUDY OBJECTIVE: To test patient engagement and satisfaction with mobile app menstrual monitoring in young adolescents. We hypothesized that at least two-thirds of study participants would demonstrate sustained engagemen...STUDY OBJECTIVE: To test patient engagement and satisfaction with mobile app menstrual monitoring in young adolescents. We hypothesized that at least two-thirds of study participants would demonstrate sustained engagement with menstrual tracking over 6 months. METHODS: The study cohort included menstruating adolescents 10-14 years of age with regular access to a smartphone or tablet. Our study design allowed for a completely remote participant experience, and participants were primarily recruited through electronic platforms. Participants used our HIPAA-compliant Teen-Period (T-Dot) mobile app to track menstrual bleeding and related symptoms over a 6-month timeframe. RESULTS: A total of 156 participants were included in the data analysis (median age 13 years, IQR 12-14). One hundred participants (64.1%) met the primary outcome of engagement with T-Dot, meaning they entered data for ≥3 menses. Usability of T-Dot was positively rated by study participants, with the majority agreeing or strongly agreeing that T-Dot was easy to use (n = 108, 74.5%) and helped to track menses effectively (n = 104, 77.2%). Usability scores did not decrease from Week 6 to Month 6, nor did the frequency of T-Dot use. Participant engagement did not differ significantly by age, race, body weight, or presence of heavy menstrual bleeding. CONCLUSION: In this preliminary study of a teen-focused HIPAA-compliant menstrual tracking app, we achieved our enrollment goals and successfully implemented a decentralized prospective cohort study. Our findings demonstrate that menstrual tracking research is possible even in early adolescents.
Juvenile gigantomastia is a rare condition showing progressive breast enlargement during puberty. Here, we report a rare case of a 12-year-old female patient who developed rapid bilateral breast hypertrophy following men...Juvenile gigantomastia is a rare condition showing progressive breast enlargement during puberty. Here, we report a rare case of a 12-year-old female patient who developed rapid bilateral breast hypertrophy following menarche. The patient has complex family history of consanguineous marriage and individual history of suspected Madelung's disease during her infancy. After examinations and muti-department consultation, we did bilateral mastectomy to address the severe breast enlargement, and planned to perform breast reconstruction surgery after complete sexual maturity. The histopathological investigations revealed the presence of pseudo angiomatous stromal hyperplasia (PASH). Genetic analysis was conducted to explore potential hereditary contributions to the condition. During six months of follow-up period, no new breast lumps or enlargement occurred, and the patient had no postoperative complications such as infection and hematoma.
INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis, rarely affecting the genitourinary tract. Vulvar involvement is extremely uncommon and often misdiagnosed. CASE PRESENTATION: A 21-year-...INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis, rarely affecting the genitourinary tract. Vulvar involvement is extremely uncommon and often misdiagnosed. CASE PRESENTATION: A 21-year-old female patient presented with a 1-month history of necrotic vulvar lesions and skin ulcerations. The markedly elevated PR3-ANCA and histopathological findings supported the diagnosis of GPA. Imaging methods revealed multiple spleen infarctions and pseudo-masses in the kidneys; endocranial MRI showed pansinusitis and otomastoiditis. Initial treatment with systemic corticosteroids and methotrexate was insufficient; however, rituximab achieved significant improvement, resulting in complete healing of both vulvar and skin lesions. CONCLUSION: Vulvar GPA, though rare, may be the initial sign of systemic vasculitis. Multidisciplinary evaluation is important for early diagnosis and effective immunosuppressive therapy.
STUDY OBJECTIVE: This study compares the demographic characteristics and experiences of three different groups of adolescent and young adults (AYAs) seeking nonsedated intrauterine device (IUD) insertion in the outpatien...STUDY OBJECTIVE: This study compares the demographic characteristics and experiences of three different groups of adolescent and young adults (AYAs) seeking nonsedated intrauterine device (IUD) insertion in the outpatient setting: (1) cisgender individuals, (2) transgender and gender diverse (TGD) individuals receiving gender-affirming testosterone therapy, and (3) TGD individuals not receiving gender-affirming testosterone therapy. METHODS: This retrospective cohort study included AYAs age 13-21 years seeking IUD insertion. Data were obtained from the electronic health record via a pre-existing, multi-institutional shared quality improvement collaborative. The patient population was characterized by descriptive statistics; inferential statistics compared procedural complications, outcomes, and patient-reported side effects. Unadjusted Kaplan-Meier and Cox proportional-hazard modeling assessed continuation rates. RESULTS: Of the 683 participants attempting IUD insertion, 623 were cisgender individuals, 18 were TGD individuals on gender-affirming testosterone, and 42 were TGD individuals not on testosterone. There was no difference in insertion indication (P = .25). TGD patients on testosterone were more likely to have experienced a procedural adverse event (17%; P = .04), and to have reported pain beyond expectation (P = .003), although insertional success did not differ significantly between groups (P = .22). CONCLUSION: TGD AYAs had similar reasons as cisgender patients for seeking the IUD. While TGD individuals on testosterone were more likely to have pain or an adverse procedural event, insertional success did not differ. One-year IUD continuation rates were similarly high in all groups.
BACKGROUND: Up to 10%-12% of individuals with Turner syndrome (TS) have Y chromosome material (eg, 45,X/46,XY), which can lead to virilization. We present the case of a patient with TS who developed virilization due to o...BACKGROUND: Up to 10%-12% of individuals with Turner syndrome (TS) have Y chromosome material (eg, 45,X/46,XY), which can lead to virilization. We present the case of a patient with TS who developed virilization due to ovarian hilus cell (OHC) hyperplasia. CLINICAL CASE: An 11-year-old with TS presented with clitoromegaly, hyperandrogenism, and primary ovarian insufficiency (POI). Thorough workup was unable to identify the source of hyperandrogenism. She underwent laparoscopic bilateral gonadectomy and was diagnosed with OHC hyperplasia on pathologic evaluation. Hyperandrogenism resolved postoperatively. CONCLUSION: OHC hyperplasia is a rare but important diagnosis to consider. Laparoscopic bilateral gonadectomy is both diagnostic and therapeutic and should be considered a first-line treatment for patients with POI and virilization in the absence of other diagnosed etiology.
STUDY OBJECTIVE: This study aims to assess the association between sleep quality and menstrual cycle abnormalities in adolescent females in the United States (U.S.). In doing so, we address the gap in adolescent menstrua...STUDY OBJECTIVE: This study aims to assess the association between sleep quality and menstrual cycle abnormalities in adolescent females in the United States (U.S.). In doing so, we address the gap in adolescent menstrual health by providing baseline data that can inform future sleep and menstrual health interventions. METHODS: An Institutional Review Board (IRB) approved, anonymous survey was distributed to new patients at an academic pediatric gynecology clinic. Exclusion criteria included age over 21, hormonal contraceptive use, prior chemotherapy, or reproductive disorders. Electronic consent was obtained. The survey included the Pittsburgh Sleep Quality Index (PSQI), menstrual cycle data, comorbidities, and demographic data. Continuous variables were analyzed using linear regression and categorical variables using chi-square (with P < .05 considered significant). Odds ratios (OR) were reported with 95% confidence intervals (CI). RESULTS: Among the 100 analyzed responses, 84.0% identified as Hispanic, with over one-third (37.0%) being born outside of the U.S. Sixty-three had poor sleep quality (PSQI > 5), and 64 had abnormal menses. Higher PSQI scores were significantly associated with abnormal menses (OR = 1.15, CI = 1.01, 1.32, P = .04). Poor sleep correlated with prior anxiety (χ² = 6.84, P = .01) and depression diagnoses (χ² = 3.89, P = .05). CONCLUSION: Our findings suggest a significant relationship between poor sleep quality and menstrual abnormalities, emphasizing the need to evaluate sleep when managing adolescent menstrual health. Future research is needed to gain deeper insights into the mechanistic link between the two and the broader implications of this association.
INTRODUCTION: Prader-Willi syndrome (PWS) is associated with hypogonadism. Limited data exist on guidelines for sex hormone replacement therapy (HRT) in females with PWS. We aimed to characterize pubertal timing, vaginal...INTRODUCTION: Prader-Willi syndrome (PWS) is associated with hypogonadism. Limited data exist on guidelines for sex hormone replacement therapy (HRT) in females with PWS. We aimed to characterize pubertal timing, vaginal bleeding patterns, and HRT practices in adolescent and young adult females with PWS. METHODS: We conducted a retrospective review of females ages 5-25 years, diagnosed with PWS, at a single institution (01/2013-09/2023). Demographic and clinical data were abstracted from electronic medical records and analyzed with descriptive statistics. Patients were classified as having complete hypogonadotropic hypogonadism (HH) (luteinizing hormone [LH] <0.3 mIU/mL or lack of thelarche by 13 years) or partial hypogonadism (PH) (LH >0.3 mIU/mL and estradiol <20 pg/mL or amenorrhea by 15 years). RESULTS: Fifty-one patients met inclusion criteria; 21 (41%) were diagnosed with hypogonadism and were included in the final analysis. Of these patients, 8 (38.1%) had HH and 13 (61.9%) PH. Delayed puberty was diagnosed at a median of 13.5 years (range: 10-15) in the HH cohort and at 14.5 years (range: 13-18) in the PH cohort. Six patients (28.6%) reported spontaneous vaginal bleeding, median age of 14.0 (range: 10-16) years. Eighteen patients (85.7%) were prescribed HRT at a median of 14.0 (range: 12-21) years, of which 8 (44.4%) discontinued HRT, with half reporting breakthrough bleeding. DISCUSSION: Hypogonadism is common among adolescent and young adult females with PWS. We found high rates of HRT discontinuation primarily due to breakthrough bleeding. These findings highlight the need to tailor HRT regimens and identify strategies to encourage HRT adherence to optimize long-term outcomes.
STUDY OBJECTIVE: Turner Syndrome (TS) is a genetic condition often characterized by ovarian insufficiency and infertility. Fertility preservation discussions are recommended early in care, but few studies have explored p...STUDY OBJECTIVE: Turner Syndrome (TS) is a genetic condition often characterized by ovarian insufficiency and infertility. Fertility preservation discussions are recommended early in care, but few studies have explored parental perspectives. Our objective was to assess the knowledge, perceptions, and attitudes regarding fertility and fertility preservation among parents of young children with TS. METHODS: An anonymous bilingual survey (English/Spanish) was completed by parents of children under 12 years with TS seen at a multidisciplinary clinic (April 2022-September 2023). Quantitative data were analyzed using descriptive statistics and Fisher's exact test. Open-ended responses were analyzed using conventional content analysis to identify recurring themes. RESULTS: Forty-five parents (82% mothers) completed the survey, with 60% identifying as non-Hispanic white (NHW), 20% Hispanic, 11% Black, and 9% other. All were aware of the association of infertility with TS. NHW respondents were more likely to have a higher income, educational status and private insurance (P < .05). We found differences by race/ethnicity regarding the value of biological parenthood and openness to fertility preservation options as well as factors that contribute to these decisions. Cost emerged as a major consideration across all income groups. Despite high counseling rates (>90%), only 60% of parents recalled fertility discussions. Themes from open-ended responses emphasized cost, procedural risk/benefit, child autonomy, divergent opinions on timing of counseling, and a desire for more information. CONCLUSION: This study highlights the varied perspectives and priorities voiced by parents of young children with TS regarding fertility preservation and can inform fertility counseling practices by providers.
BACKGROUND: Mitotically active cellular fibroma (MACF) of the ovary is a rare stromal tumor, representing an intermediate entity between cellular fibromas and fibrosarcomas. While fibrosarcomas show aggressive clinical b...BACKGROUND: Mitotically active cellular fibroma (MACF) of the ovary is a rare stromal tumor, representing an intermediate entity between cellular fibromas and fibrosarcomas. While fibrosarcomas show aggressive clinical behavior with nuclear atypia and high mitotic counts, MACFs demonstrate increased mitotic activity without atypia. Pediatric cases are exceptionally uncommon. CASE: A 15-year-old adolescent presented with an adnexal mass. Surgical excision revealed a large ovarian tumor, confirmed histopathologically as a mitotically active cellular fibroma. The tumor was the largest and heaviest MACF reported in a pediatric patient to date. The postoperative course was uneventful, and the patient remains under follow-up without recurrence. CONCLUSION: Ovarian MACF is a rare diagnosis in children and adolescents. Its recognition is important, as it carries intermediate malignant potential and may mimic fibrosarcoma. Accurate histopathological evaluation is essential to guide management and prevent overtreatment, while ensuring appropriate follow-up for early detection of recurrence.
STUDY OBJECTIVE: This multi-institutional, retrospective study explores the risks of laparoscopy for diagnosis and treatment of endometriosis to facilitate shared medical decision-making in patients age < 22 years old wi...STUDY OBJECTIVE: This multi-institutional, retrospective study explores the risks of laparoscopy for diagnosis and treatment of endometriosis to facilitate shared medical decision-making in patients age < 22 years old with chronic pain considering surgery. METHODS: A retrospective review of patients less than 22 years old who had surgically proven endometriosis at eight pediatric hospitals was completed. Patient demographics, operative interventions, concurrent procedures, and complications were evaluated. RESULTS: There were 284 patients with pathologically confirmed endometriosis with a median age of 16.86 years (15.51, 18.06). During the index procedure, diagnostic biopsy alone was performed (35.92%), followed by ablation (29.93%), excision (20.07%), excision and ablation (12.68%), and cryoablation (1.41%). Most common procedures performed concurrently included LNG-IUS placement (58.10%), ovarian cystectomy (11.27%), endoscopy (1.76%), and appendectomy (1.41%). Most patients (86.27%) experienced no postoperative complications within 30 days of the procedure. Significant postoperative pain was seen in 14 patients (4.93%) with 9 patients (3.17%) requiring additional narcotics and 5 patients (1.76%) requiring admission for pain control. One patient experienced a venous thromboembolism (0.35%). Reoperation rate was 12.32% with a median interval of 1.7 years (IQR: 0.93, 4) from initial surgery. CONCLUSIONS: We demonstrate that laparoscopy for diagnosis and/or treatment of endometriosis has low complication and reoperation rates in adolescent and young adult patients. Performing concurrent indicated procedures, particularly LNG-IUS placement, is safe and should be considered to avoid additional anesthesia exposure and cost. Anticipatory guidance regarding postoperative pain may be beneficial in this patient population. This evidence-based data aids in shared medical decision-making.
OBJECTIVE: To compare the thickness and contractile performance (CP) of the transversus abdominis (TrA) and internal oblique (IO) muscles and diaphragm in young adult and nulliparous women with and without primary dysmen...OBJECTIVE: To compare the thickness and contractile performance (CP) of the transversus abdominis (TrA) and internal oblique (IO) muscles and diaphragm in young adult and nulliparous women with and without primary dysmenorrhea (PD) METHODS: Women with (PD group, n = 30) and without PD (control group, n = 30) were included. Menstrual pain intensity using a 10-cm visual analog scale was assessed. TrA and IO thickness, both in a resting state and during the abdominal drawing-in maneuver (ADIM) with an 11 MHz linear probe, and diaphragm thickness at the end of maximum inspiration and expiration with a 1-6 MHz convex probe were measured. The percentage of change (PC) in both the thickness and CP of these muscles was calculated. RESULTS: The mean pain intensity of the PD group was 7.18 ± 1.22 cm. No difference was detected between groups in terms of the thickness of the TrA and IO muscles at rest and during ADIM and the thickness of the diaphragm at the end of deep inspiration and expiration (P > .05). The PC in the thickness and CP of the TrAright and TrAleft muscles was smaller in the PD group than in the control group (P < .05). No difference was found between groups in terms of the PC in the thickness and CP of IOright, IOleft, and diaphragm (P > .05). CONCLUSION: The PC in the thickness and CP of the TrA muscle was smaller in women with PD than in women without PD. Therefore, it may be important to consider the decreased PC in the TrA muscle thickness with the ADIM as compared with the thickness at rest and to provide exercise training in the management of PD.
Wilkinson TA, Coleman F, Chaku N
… +4 more, Peipert JF, Wiehe SE, Carroll AE, Fortenberry JD
J Pediatr Adolesc Gynecol
· 2025 Dec · PMID 40714268
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OBJECTIVES: While increasing access to contraception is important, young people often face barriers to access prior to, within and after engagement with clinical care. The objective was to examine the feasibility of a pi...OBJECTIVES: While increasing access to contraception is important, young people often face barriers to access prior to, within and after engagement with clinical care. The objective was to examine the feasibility of a pilot adolescent and young adult (AYA) birth control navigator program. METHODS: An online and in-person outreach strategy was launched in central Indiana starting in June 2023 to reach AYA outside of clinical settings and connect them to a trained navigator. Various communication platforms were used and a link to a validated contraception decision aid and barrier assessment was sent. After program support, AYA were invited to participate in a research cohort and complete a baseline survey. RESULTS: The outreach strategy included social media advertising with 4,327,614 impressions and 30,210 clicks and 17 social media ambassadors with 96 posts. Of the 30 people who connected with the navigator, 18 (60%) participated in the post-programmatic research cohort. Participants had a mean age of 17.3 years (range 15-19), 33% identified as African American and 61% reported being sexually active. Addressed barriers included appointment booking (73%), access confidential care (67%) and support around transportation (30%). All participants (100%) reported that the navigator listened to them, provided helpful information, and made them feel comfortable. However, only 8 (67%) reported high-quality person-centered care was experienced during clinical encounters. CONCLUSIONS: A human-centered designed birth control navigator pilot program can provide AYA's personalized assistance with overcoming barriers faced. Recruitment outside of clinical environments of AYA in a restrictive state was challenging, despite online outreach strategies.
INTRODUCTION: Self-managed abortions are increasingly common globally, but little is known about young women's experiences. METHODS: Secondary analysis of data from 1847 women accessing MA in urban Cambodia in 2018-2019...INTRODUCTION: Self-managed abortions are increasingly common globally, but little is known about young women's experiences. METHODS: Secondary analysis of data from 1847 women accessing MA in urban Cambodia in 2018-2019 and in-depth interviews with seven women aged 15-19. Descriptive statistics compared young and adult women on self-reported abortion outcomes and experiences in clinics and pharmacies, and qualitative data contextualized quantitative findings. RESULTS: Young women were better represented among clinic clients (30.0%) compared to pharmacy clients (20.2%). Young women had comparable MA success rates and better MA experiences across settings, but young pharmacy clients were more likely to seek support from friends and family. DISCUSSION: Young women had comparable MA outcomes and experiences as adult women in both clinics and pharmacies, but young women self-managing their abortions may require information and support beyond the pharmacist.
STUDY OBJECTIVE: Access to contraceptive services is essential for adolescents to pursue sexual and reproductive well-being. Publicly supported family planning clinics are critical reproductive health safety net provider...STUDY OBJECTIVE: Access to contraceptive services is essential for adolescents to pursue sexual and reproductive well-being. Publicly supported family planning clinics are critical reproductive health safety net providers and are an essential source of contraceptive care for adolescents. Contraceptive care for adolescents should be centered on their needs to ensure reproductive autonomy. METHODS: We fielded a national survey of publicly supported family planning clinics in the United States and conducted a cross-sectional analysis to understand the extent to which these clinics provide contraceptive services that are adolescent-centered. We also examined differences by clinic type and by state policies on adolescents' consent to contraceptive care. RESULTS: Many clinics have taken strides to provide adolescent-centered contraceptive care, but gaps in this care still exist, particularly among federally qualified health centers. CONCLUSION: Gaps in the provision of adolescent-centered care should be addressed to ensure that adolescent populations are receiving high quality contraceptive care.
Villena C, Brookhart CD, Das K
… +2 more, Naroji S, Gomez-Lobo V
J Pediatr Adolesc Gynecol
· 2025 Dec · PMID 40683524
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BACKGROUND: 46XY Complete Gonadal Dysgenesis (CGD), also known as Swyer syndrome, is characterized by nonfunctional streak gonads and an increased risk of gonadal neoplasms. While spontaneous puberty is not expected, hor...BACKGROUND: 46XY Complete Gonadal Dysgenesis (CGD), also known as Swyer syndrome, is characterized by nonfunctional streak gonads and an increased risk of gonadal neoplasms. While spontaneous puberty is not expected, hormonally active gonadal tumors can mimic normal puberty delaying diagnosis. CASE PRESENTATION: We present two adolescents with 46XY CGD and tumor-driven puberty: a 16-year-old with spontaneous thelarche and adrenarche found to have a left gonadoblastoma, and a 14-year-old with spontaneous menarche and pelvic pain who was subsequently diagnosed with a dysgerminoma and a sex cord tumor with annular tubules (SCTAT). DISCUSSION & CONCLUSION: Puberty in patients with 46XY CGD should prompt suspicion for gonadal tumors. Early recognition and gonadectomy are crucial to prevent malignant transformation and optimize outcomes.
STUDY OBJECTIVE: Ultrasound (US) is the gold standard for evaluation of pelvic organs; however, achieving a full bladder can be challenging for children. Recent studies have shown excellent diagnostic performance of rapi...STUDY OBJECTIVE: Ultrasound (US) is the gold standard for evaluation of pelvic organs; however, achieving a full bladder can be challenging for children. Recent studies have shown excellent diagnostic performance of rapid MRI for acute appendicitis. As MRI becomes more prevalent in the evaluation of right lower quadrant pain, its use for gynecologic indications should be reevaluated. METHODS: A retrospective review of patients who had rapid MRI examinations performed in the emergency department (ED) for right lower quadrant pain at a single institution was conducted from August 2022 through August 2023. A time-matched control group with US evaluation for the same indication was obtained. A rapid, non-contrast three-sequence free-breathing MRI protocol was utilized. RESULTS: Of the 376 rapid MRI exams performed for the indication of right lower quadrant pain, 49 were noted to have gynecologic pathology identified. Of the 250 time-matched US controls, 51 were noted to have gynecologic pathology. The median MRI scan time (first image to last image) was 10 minutes. The total length of stay in the ED was significantly shorter in the rapid MRI group than in the controls (median 338 minutes vs 442 minutes, P < .05). Time to imaging diagnosis was significantly shorter in the rapid MRI group (201 minutes vs 285 minutes, P < .01). Time to gynecology consultation was not significantly different between groups (238 minutes vs 253 minutes, P = .66). CONCLUSION: First-line, rapid MRI for evaluation of gynecologic processes can provide imaging diagnoses faster than using US and results in lower overall lengths of stay in the ED.
Heavy menstrual bleeding is a common condition encountered in the adolescent patient population. The objective of this consensus guideline is to provide the latest evidence regarding the use of tranexamic acid as a treat...Heavy menstrual bleeding is a common condition encountered in the adolescent patient population. The objective of this consensus guideline is to provide the latest evidence regarding the use of tranexamic acid as a treatment modality for heavy menstrual bleeding in this age group. METHODS: A PubMed search was completed on December 5, 2024 for all articles published since 1970 using (tranexamic acid or "tranexamic acid" or "TXA") and (menorrhagia or "heavy menstrual bleeding") and ("adolescent" or "teenager" or "teen" or "pediatric"). A second search using (tranexamic acid or "tranexamic acid" or "TXA") AND (menorrhagia or "heavy menstrual bleeding") was done using PubMed, the Cochrane Database of Systematic Reviews, and the Cochrane Library.