My granddaughter is 13. She started her periods about six months ago. Her periods last for 10 to 20 or more days. Her doctor says she is too young to be treated for this problem now, but that she can use birth control pills at a later time to regulate her menses. Is there nothing to be done to help her? This is very stressful for her. She is a very petite young lady, and I'm concerned about her becoming anemic.

Patricia

Irregular cycles are the norm shortly after the beginning of menstruation, but bleeding longer than eight to 10 days is abnormal. A hematocrit (blood count) should be done to check for anemia. If the bleeding is very heavy, as well as prolonged, then tests of the blood's ability to clot should also be performed; some young women with von Willebrand's disease are diagnosed only because of heavy menstrual bleeding. Thyroid function should also be assessed by means of a blood test.

There are several different ways to approach abnormal bleeding in an adolescent, and which to choose depends on the severity of bleeding, the presence of medical conditions contributing to the bleeding, and the wishes of patient and parent. For mild cases without anemia, ibuprofen (Motrin, Advil) or naproxen sodium (Anaprox, Aleve) taken during the period may reduce the amount of bleeding. Birth control pills can be used, and in many ways they are the most effective treatment. Concerns about birth control pill use in girls are related to the fact that high-dose estrogen can cause premature fusion of bones and a shorter-than-anticipated height; however, because the growth spurt precedes the onset of menstruation, this is rarely a problem in this type of situation. Some young women do not tolerate the pill, or their parents may oppose its use; Provera is used in these circumstances. Provera is given in a cyclic fashion, usually for three to six months. If anemia or borderline anemia is diagnosed, then iron supplements should be taken as well.

If your granddaughter's problem persists, she should be evaluated by a gynecologist, or, if you live in a large city and one is available, a pediatric gynecologist.