Abstract
Women bleed with menses, during childbirth, and after childbirth. Women are more likely
to manifest a bleeding disorder as they have more opportunities to experience bleeding
challenges in their lifetime. Bleeding disorders such as hemophilia and von Willebrand
disease affect 2.5–3 million American women. The most common inherited bleeding disorder
in the population is von Willebrand disease with an estimated prevalence of 1–2%.
von Willebrand factor (vWF) is required to adhere platelets to exposed subendothelium
and protects factor VIII from proteolysis in the circulation.1 The prevalence of vWF rises in studies involving women with menorrhagia, with estimates
ranging as high as 10–20% in white women, and 1–2% among African American women.2 Other bleeding disorders seen in adolescents with menorrhagia are disorders of inherited
platelet dysfunction, clotting factor deficiencies, thrombocytopenia, and disorders
of the fibrinolytic pathway. Not only are women more likely to present early in their
life with a bleeding disorder, they are also more likely to have other gynecologic
manifestations as a result of these disorders. This article presents an overview of
the problem and touches upon the different management strategies available.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Bleeding disorders in adolescents.in: Hertweck P. Obstetrics and Gynecology Clinics of North America: Pediatric and Adolescent Gynecology. WB Saunders, Philadelphia2009: 153-162
- More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders.Haemophilia. 2005; 11: 295
- Bernard-Soulier syndrome.Blood. 1998; 91: 4397
- Glanzmann's thrombasthenia: the spectrum of clinical disease.Blood. 1990; 75: 1383
- Bleeding risk and reproductive capacity among patients with factor XIII deficiency: a case presentation and review of the literature.Obstet Gynecol Surv. 2000; 55: 103
- Bleeding and thrombosis in 55 patients with inherited afibrinogenaemia.Br J Haematol. 1999; 107: 204
- Pattern of symptoms in 93 Iranian patients with severe factor XIII deficiency.J Thromb Haemost. 2003; 1: 1852
- Combined factor V and VIII deficiency in Indian population.Haemophilia. 2000; 6: 504
- Age and the prevalence of bleeding disorders in women with menorrhagia.Obstet Gynecol. 2005; 105: 61
- Acute adolescent menorrhagia.Am J Obstet Gynecol. 1981; 139: 277
- Menorrhagia in adolescents requiring hospitalization.J Pediatr Adolesc Gynecol. 1988; 11: 13
- Hematological abnormalities in adolescent menorrhagia.Arch Gynecol Obstet. 2002; 266: 72
- Bleeding disorders: a common cause of menorrhagia in adolescents.J Pediatr. 2001; 138: 856
- Bleeding disorders in teenagers presenting with menorrhagia.Aust N Z J Obstet Gynaecol. 2005; 45: 439
- The prevalence of disorders of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre.Haemophilia. 2007; 13: 627
- American College of Obstetricians and Gynecologists: Menstruation in girls and adolescents:using the menstrual cycle as a vital sign.ACOG, Washington DC2006
- American College of Obstetricians and Gynecologists: Management of anovulatory bleeding.ACOG, Washington DC2000
- Menorrhagia I: measured blood loss, clinical features, and outcomes in women with heavy periods: a survey with follow-up data.Am J Obstet Gynecol. 2004; 190: 1216
- Assessment of menstrual blood loss using a pictorial chart.Br J Obstet Gynecol. 1990; 97: 734
- Assessment of menstrual blood loss using a pictorial chart: a validation study.BJOG. 2000; 107: 320
- von Willebrand's disease in Sweden.Acta Paediatr Scand Suppl. 1973; 238: 1
- Medical, reproductive and psychosocial experiences of women diagnosed with von Willebrand's disease receiving care in haemophilia treatment centres: a case-control study.Haemophilia. 2003; 9: 292
- Development of a screening tool for indentifying women with menorrhagia for hemostatic evaluation.Am J Obstet Gynecol. 2008; 198: 163.e1
- Current understanding of von Willebrand's disease in women - some answers, more questions.Haemophilia. 2006; 12: 143
- Screening women with menorrhagia for underlying bleeding disorders: the utility of the platelet function analyser and bleeding time.Haemophilia. 2005; 11: 497
- Platelet function analyzer (PFA)-100 closure time in the evaluation of platelet disorders and platelet function.J Thromb Haemost. 2006; 4: 312
- The reproductive health of women with von Willebrand disease unresponsive to DDAVP: results of an international survey. On behalf of the Subcommittee on von Willebrand Factor of the Scientific and Standardization Committee of the ISTH.Thromb Haemost. 1995; 74: 784
- Effects of oral contraceptives on blood coagulation. A review.Obstet Gynecol Surv. 1985; 40: 425
- Variations in coagulation factors in women: effects of age, ethnicity, menstrual cycle and combined oral contraceptive.Thromb Haemost. 1999; 82: 1456
- Effects on coagulation of levonorgestrel- and desogestrel-containing low dose oral contraceptives: a cross-over study.Thromb Haemost. 2000; 84: 4
- The use of the levonorgestrel-releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders.BJOG. 2004; 111: 1425
- Menorrhagia in adolescents with inherited bleeding disorders.J Pediatr Adolesc Gynecol. 2010; 23: 215
Kailashnath V, Hertweck P, Bertolone S, et al: Response Rates of High and Low Dose Estrogen and Their Combination with DDAVP and/or Aminocaproic Acid in Patients with Menorrhagia and Type I Von Willebrand's Disease. 2008 Annual Meeting of the American Society of Hematology. San Francisco, CA
- Cellular mechanisms of the hemostatic effects of desmopressin (DDAVP).J Thromb Haemost. 2003; 1: 682
- Oral contraceptives and DDAVP nasal spray: patterns of use in managing vWD-associated menorrhagia: a single-institution study.J Pediatr Hematol Oncol. 2005; 27: 357
- Hemostatic drugs.N Engl J Med. 1998; 339: 245
- Antifibrinolytics for heavy menstrual bleeding.Cochrane Database Syst Rev. 2000; (CD000249)
- Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic.Br J Haematol. 2009; 145: 212
- No increased risk of venous thrombosis in women taking tranexamic acid.Thromb Haemost. 2001; 86: 714
- Bleeding disorders and heavy menses in adolescents.Curr Opin Obstet Gynecol. 2007; 19: 415
Lukes A, Waldbaum A, Eder SE, et al: A novel, oral Tranexamic acid formulation for heavy menstrual bleeding: A dose-response analysis. (Abstract/Poster) presented at the 58th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, San Francisco, California May 18, 2010.
- Haemorrhagic problems in obsterics and gynaecology in patients with congenital coagulopathies.Br J Obstet Gynaecol. 1991; 98: 909
- An unusual method to manage a rare blood dyscrasia.J Pediatr Adolesc Gynecol. 2003; 20: S123
- Uterine artery embolization for control of life-threatening hemorrhage at menarche: brief report.J Vasc Interv Radiol. 2001; 18: 127
- Severe juvenile vaginal bleeding due to Glanzmann's thrombasthenia: case report and review of the literature.Am J Hematol. 1998; 57: 225
Article info
Publication history
Published online: October 11, 2010
Footnotes
The authors have disclosed no conflicts of interest.
Identification
Copyright
© 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
