Background: Among adolescent with heavy menstrual bleeding (HMB), there is a considerable 
number of adolescent who have bleeding tendency or bleeding disorders. This study aimed to discuss 
the pattern of menstruation and the management of the HMB in girls with bleeding disorders. 
Methods: In this retrospective study, we included girls aged 9-18 years old who had established 
bleeding tendency due to bleeding disorders in our pediatric hematology clinic. These girls were 
referred to the pediatrics gynecology clinic to reviews their pattern of menstruation and the treatment 
of their HMB. Results: Among 58 girls reviewed, 51 were included in our analysis, 34 of them were 
already had menarche. Among these post-menarcheal girls, 16 girls revealed HMB at menarche. The 
menstruation of girls with bleeding disorder related to defect in von Willebr and factor lasted more 
than seven days. The hormonal therapy was the first line of treatment of HMB; however, 50.9% of 
them failed the first line of treatment. Therefore, the second line of treatment, combined hormonal and 
non-hormonal therapy, was started for them. Conclusion: The risk of HMB after menarche is 
increased in young girls with bleeding disorders. Premenstrual counseling with pediatrics 
gynecologist and hematologist is recommended for young girls with bleeding disorders to discuss the 
pattern of menstrual bleeding and the possible treatment of the heady bleeding.