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Causes of menorrhagia can be divided into systemic disorders and specific uterine abnormalities.

Intrauterine pregnancy, ectopic pregnancy, and miscarriage, must be at the top of the differential diagnosis list for any woman presenting with heavy menses. In several studies of adolescents with acute menorrhagia, underlying bleeding disorders accounted for 3% to 13% of emergency department visits. von Willebrand s disease has an incidence of 1% in the general population and may present initially as heavy menses in an adolescent.8 Hypothyroidism also may be associated with heavy menses. Specific uterine causes of menorrhagia are more common in older childbearing women, and they include fibroids, adenomyosis, endometrial polyps, and gynecologic malignancies.

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