By Dr. Pier Boutin, MD
Something happened to my daughter when she turned fourteen. She moaned, “Mom, I’m tired” and would escape to her room. I thought “this is normal at her age”. Her older brother used to sleep all the time at that age.
After a few weeks of this behavior, I decided to crack the door of her bedroom open without making a sound. I was sure I would find her on her cell phone flipping through twitter or watching a movie. But no, she lay sound asleep in the most awkward positions as if she was in the midst of a thought and passed out. I could have played the drums and she would have kept on sleeping.
For months, I attributed her increased need for sleep to puberty. She’s growing and growing fast. Right? The “tiredness” became so intense that she would make excuses to avoid her friends. That’s when I decided that this situation is no longer typical of a teenage girl.
There was another clue that something was amiss. When my daughter had her period, she always worried that her tampon might leak through. It turns out she had good reason to fret. Her menses had become so heavy that she had to change her super-sized tampon every few hours. She even had to put her alarm at night to change her tampon to avoid staining the sheets. I thought this would settle as her hormones stabilized. Nope, it didn’t.
Her gynecologist started her on the pill. I don’t like the idea of non-bioidentical hormones for anyone, let alone my daughter. There were no other options. In my mind, I convinced myself this would be a magic solution. Nope! Her menses began to last over two weeks and cycled every three weeks. Okay, tampons are expensive! She tried a stronger birth control pill. Again no change – still bleeding too much. A third and even stronger pill made no difference.
At this point, blood tests were ordered and revealed that my daughter had Von Willebrand disease. This had never crossed my mind. What? Yes, this is not a disease, it’s a clotting factor deficiency. That means she bleeds easily. Now that I think back, I remember how she used to regularly wake up with nose bleeds in the middle of the night. I thought it was the A/C.
For over a year, I attributed her fatigue to puberty and heavy menstrual cycles typical of teenage girls. No, my daughter had Von Willebrand disease. There is no treatment. Her monthly bleeding went uncontrolled. Her hemoglobin and iron storage levels kept dropping. Her fatigue persisted. Finally, the gynecologist with the hematologist recommended a progesterone intrauterine device. It worked!
Almost two years later, blood tests demonstrated that my daughter’s hemoglobin level was normal and iron storage level climbing back up to normal range. Yay, but then my daughter started sleeping 15 hours a day and was really dragging. She fell asleep at the dining table. She complained of lightheadedness going up the stairs.
So we schlep back to the doctor’s office. A new series of test show that my daughter has mono. What? She was home for the entire Covid pandemic. She didn’t even go back to in-person classes when school opened up again. There is no treatment for mono, Epstein-Barr virus, except to let her sleep and rest.
I share my story because on so many levels, even as a doctor, I missed the mark. So many factors may contribute to fatigue in teenagers. This isn’t always a medical mystery that’s easy to solve.
Do teens love their sleep? Sure. But pay attention to your constantly fatigued and tired teen to make sure you’re not missing the signs of a deeper health issue.
