FLO Program (Flowing Lightly Onwards)
Heavy Menstrual Bleeding Care for Children and Teens
If your child or teen is experiencing heavy menstrual bleeding, help is available. CHKD’s multidisciplinary hematology/gynecology program, or FLO (Flowing Lightly Onwards) Program, brings together specialists from pediatric hematology and pediatric and adolescent gynecology to diagnose and manage heavy or prolonged menstrual bleeding. Meet the care team.
The FLO Program is held once a month on Tuesday afternoons in the Children’s Cancer and Blood Disorders Center.
Please note: A multidisciplinary appointment can last 1–2 hours and typically includes a physical exam, though a pelvic gynecologic exam is usually not necessary. See additional information about what to expect below.
Conditions We Treat
The FLO Program supports patients with:
- Heavy or prolonged menstrual bleeding
- Menstrual bleeding that interferes with school, sports, or daily activities
- Anemia or iron deficiency related to menstrual bleeding
- Hematologic conditions such as sickle cell anemia
- Suspected or known bleeding disorders and/or clotting disorders
- Complex menstrual concerns that benefit from coordinated specialty care
When should I seek help for my child’s heavy menstrual bleeding?
Some heavy bleeding on the first day of a menstrual cycle can be normal. You should seek medical care if your child has heavy or irregular menstrual bleeding that is lasting longer than seven days and/or heavier than normal day-to-day.
Signs and symptoms of heavy menstrual bleeding:
- Soaking through a pad or tampon in 1–2 hours for multiple hours
- Needing to get up overnight to change pads
- Doubling up pads to control flow
- Passing clots the size of a quarter or larger
- Bleeding for longer than seven days
- Anemia, fatigue, or shortness of breath
- A sensation of gushing or flooding
- Flow that restricts normal activities (school, sports, sleep, social events)
Could heavy menstrual flow be caused by a bleeding disorder?
Yes. Some patients with heavy menstrual flow may have an underlying bleeding disorder.
Signs a bleeding disorder could be the cause:
- Family history of heavy or prolonged menstrual cycles, postpartum hemorrhage
- Bleeding associated with dental work
- History of nosebleeds lasting longer than 10 minutes
- Personal or family history of other bleeding symptoms such as bruising
- Prolonged bleeding after surgery or dental procedures
Who should I see about my child’s heavy menstrual bleeding?
Start by scheduling a visit with your child’s primary care provider. If needed, your child may be referred to CHKD’s FLO Program.
What treatment options are available?
Treatment is personalized for each patient and may include:
- Non-hormonal medications
- Hormonal medication management (including oral therapies, topical patches, & injections)
- Discussions about insertion of an intrauterine device (IUD)
- Iron infusions
- Blood transfusions
What to Expect
Your child will be seen by both:
- A pediatric hematologist or pediatric hematology nurse practitioner
- A pediatric and adolescent gynecologist
Comprehensive care coordination is provided by a specialty nurse coordinator, who helps ensure the care plan is clear, coordinated, and tailored to your child’s needs. They also assist with scheduling follow‑up appointments and are available to help triage questions or concerns by phone between visits.
Your child may also have access to support services as needed, including:
- Clinical pharmacy (medication education and support)
- Dietitian (nutrition guidance, including iron intake support)
- Educational Consultant (academic education and support)
- Laboratory Services
- Social work (emotional support and resources)
- Insurance card, photo ID, and co-pays if required.
- A written list of any questions or concerns you or your child may have.
- A list of current medications and supplements (including iron)
- Any recent lab results (if available)
- Notes about bleeding patterns (start date, number of days, pad/tampon changes, clots)
- Family history of bleeding symptoms (if known)
- If you have received new patient paperwork, please complete and bring it to your appointment.
Referral Information for Providers
The FLO Program accepts referrals from primary care providers and community clinicians.
To refer:
- Place a referral to Hematology in PowerChart
- Specify “FLO Program” and "Dr. Todd" in the referral comments
Questions?
Please call our Hematology Office at (757) 668-7243.
