Navigating Hormones and Gynecologic Concerns among Female Adolescents in the Settings of Thrombophilia and Anticoagulation

• There are many times when adolescent girls and women might be faced with a need to use hormones for a gynecologic indication. In this article we review the most common indications for hormonal therapies in children and adolescents.
• A review of venous thromboembolism risks in children and adolescents with the most common inherited or acquired thrombophilias is discussed.
• Gynecologic bleeding complications with anticoagulant treatment and management with hormonal and hemostatic therapy are addressed.
• To minimize the risk of venous thromboembolism when hormonal therapies for gynecologic indications are used, progestin-only methods are presented.
• There is a need for pediatric specialists and gynecologists to work with hematologists when gynecologic conditions occur concurrently with inherited or acquired thrombophilias or anticoagulation.

In the setting of an inherited or acquired thrombophilia, managing a gynecologic concern can be challenging. Nonetheless, careful consideration of the history along with a team approach to management, in which hematologists and gynecologists work together is critical. Thombophilias are important to understand, because certain types pose more risk than others. In addition, it is important to balance baseline factors, which might affect decisions regarding the best way to manage a concurrent gynecologic condition. Relative risks for thrombosis have been well studied for a variety of inherited and acquired conditions. Because of these risks, organizations such as the Centers for Disease Control and Prevention, World Health Organization, and American College of Obstetricians and Gynecologists have compiled clinical guidance recommendations to aid providers when hormonal management might be necessary (ie, to treat conditions such as delayed puberty, ovarian cysts, heavy menstrual bleeding, contraception). It is important to use these resources because there are limited prospective studies on this specific population who present with concurrent gynecologic conditions.