INTRODUCTION: Heavy menstrual bleeding (HMB) poses a significant concern among adolescents and can arise from bleeding disorders. This study aimed to compare the clinical presentations and treatment of adolescents with HMB, distinguishing those with and without an underlying bleeding disorder. METHODS: We conducted a retrospective analysis of adolescent patients presenting with HMB during 2014-2022 at specialized hematology-adolescent clinics in two tertiary referral hospitals in Israel. The study was approved by the Institutional Review Boards. RESULTS: 77 adolescents underwent evaluation for HMB, and 19 of them were diagnosed with various bleeding disorders: platelet aggregation defects (5), immune thrombocytopenia (1), Glanzmann thrombasthenia (1), VWD type 1 (5), type 2A (1), type 3 (3), and coagulation factor deficiencies (3). Notably, 38 patients (49%) were hospitalized. A higher bleeding score (BAT) significantly correlated with hospitalization and a lower hemoglobin level (p<
0.001). We did not find any significant differences between adolescents with or without a bleeding disorder regarding age of presentation, time from menarche, BAT, hemoglobin or platelet count. CONCLUSION: Our findings revealed the clinical presentations and treatments of adolescents with HMB are similar, regardless of the presence of a bleeding disorder. This emphasizes the importance of thorough evaluation in all adolescents presenting with HMB.