PB0240 - Improving Discussion of Menstrual Cycle and Bleeding During Well-Child Visits at a Pediatric Residency Clinic

Background: Menstrual health is not consistently documented by pediatric residents in well-child examinations. Average cycle blood loss is 30-40 mL or use of 3-6 soaked pads or tampons per day. Abnormal uterine bleeding (AUB) is defined as any aberration of menstrual volume, regulation, duration and/or frequency in a non-pregnant woman. The leading cause of AUB is immature hippocampal-pituitary axis followed by bleeding disorders in adolescents. Literature notes that pediatricians document screening for coagulopathy in patients with AUB with one follow-up question during 26% of encounters.

Aims: Improve menstrual cycle screening in pediatric well-child visits.

Methods: Pediatric residents were surveyed to assess menstrual screening of cycle regularity, duration, and heavy bleeding. Responses were recorded on likert scale; 1 (never) to 5 (always). A screening tool for AUB was integrated into the EMR template for well-child visits to document cycle regularity, duration, and frequency of product change. Residents received education on menses and AUB. Surveys were repeated at 3 and 6 months to assess retention. One-sided Mann-Whitney U tests with a Bonferroni correction for multiple comparisons were used to test for improvements in scores for each question comparing baseline to 3-month and to 6-month.

Results: Reported frequency of asking cycle regularity increased over the 6-month period (p=0.0118) with the median rating increasing from 4 (3, 5) to 5 (4, 5). Reported asking last menstrual period (LMP) also improved from 4 (3, 4.5) to 5 (4, 5)(p=0.0049). Reported asking about clots/gushing improved over 6 month period from 2.5 (2, 3) to 3 (3, 4)(p=0.0208) and improvement in asking frequency of menstrual product change from 3 (3, 4) to 4 (4, 5) (p=0.0181).

Conclusion(s): Utilizing a menstrual screener in note templates improves resident discussion of cycle regularity, LMP, clots, and product usage during well-child visits.