Hemostasis profile in women taking low-dose oral contraceptives

David, Jean-Louis; Gaspard, Ulysse; Gillain, Daniel; Raskinet, R.; Lepot, M.

doi:10.1016/0002-9378(90)90594-w

Cited by 56 publications

(20 citation statements)

References 9 publications

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“…There are anecdotal reports of the disappearance of bleeding symptoms during treatment, with normalization of vWF and FVIII levels in several cases [48]. A significant increase in FVIII and vWF levels in normal women on oral contraception has been shown in some but not all studies [31,[49][50][51]. However, the hemostatic effects are variable with markedly elevated clotting factor levels in some individuals [50].…”

Section: Oral Contraceptivesmentioning

confidence: 99%

“…A significant increase in FVIII and vWF levels in normal women on oral contraception has been shown in some but not all studies [31,[49][50][51]. However, the hemostatic effects are variable with markedly elevated clotting factor levels in some individuals [50]. Estrogens also inhibit endometrial proliferation, which explains their benefit in women with type 3 disease, in whom FVIII and vWF levels are unchanged.…”

Section: Oral Contraceptivesmentioning

confidence: 99%

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von Willebrand's disease and menorrhagia: Prevalence, diagnosis, and management

Kujovich¹

2005

American J Hematol

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The reported prevalence of von Willebrand's disease (vWD) is increased in women with menorrhagia, with current estimates ranging from 5% to 20%. The consistent results of multiple studies suggest testing should be included in the evaluation of patients with menorrhagia, especially in unexplained cases and prior to surgical intervention. Although a cyclic variation in von Willebrand's factor levels has not been confirmed, several studies suggest lower levels during menses and the early follicular phase. Menorrhagia is one of the most common bleeding manifestations of von Willebrand's disease, reported by 60-95% of women afflicted with this bleeding disorder. Menorrhagia is typically severe, often resulting in anemia and interfering with quality of life. Despite the frequency of menorrhagia, there is no consensus on optimal management. Although oral contraceptives are frequently prescribed, there are no studies confirming their efficacy using objective measures of response. Desmopressin was associated with an 80-92% response rate in several uncontrolled studies relying on patient assessment of efficacy. However, a small, randomized trial found no significant reduction in menstrual blood flow compared with placebo. There are anecdotal reports of the successful use of antifibrinolytic agents alone and in combination with other therapies. There are no studies comparing the relative efficacy and safety of the available medical therapies for von Willebrand's disease associated menorrhagia. Until these studies are completed, treatment should be individualized based on von Willebrand's disease subtype, patient age, contraceptive needs, and personal preference. Am.

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Section: Oral Contraceptivesmentioning

confidence: 99%

Section: Oral Contraceptivesmentioning

confidence: 99%

von Willebrand's disease and menorrhagia: Prevalence, diagnosis, and management

Kujovich¹

2005

American J Hematol

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“…Combined oral contraceptive pill (COCP) use causes a small rise in the level of VWF:Ag and VWF:RCo. In 36 women who did not have VWD the VWF:Ag and VWF:RCo rose from 88 ± 29 (IU dL −1 , mean ± SD) and 103 ± 31 to 92 ± 38 and 107 ± 46 respectively after 6 months treatment with low dose COCP [23].…”

Section: Combined Oral Contraceptive Pillmentioning

confidence: 99%

The diagnosis of von Willebrand disease: a guideline from the UK Haemophilia Centre Doctors’ Organization

et al. 2004

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Summary. von Willebrand disease (VWD) is the commonest inherited bleeding disorder. However, despite an increasing understanding of the pathophysiology of VWD, the diagnosis of VWD is frequently difficult because of uncertainty regarding the relationship between laboratory assays and function in vivo. The objective of this guideline is to provide contemporary advice on a rational approach to the diagnosis of VWD. This is the second edition of this UK Haemophilia Centre Doctors' Organisation (UKHCDO) guideline and supersedes the previous edition which was published in 1997.

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“…As for testing on OC, present preparations do not contain supraphysiological doses of oestrogen [44] and so are unlikely to affect the laboratory diagnosis of VWD. This is because the majority of studies in normal women exposed to much lower doses of oestrogen as contained in the second and third generation OC preparations have shown no significant increase in the VWF levels [39,45–48] with only a few exceptions [49]. Interestingly, in two of these studies, there was a decrease noted in the VWF levels [39,47], although this was not statistically significant.…”

Section: The Laboratory Diagnosis Of Vwd: Does Testing In Relation Tomentioning

confidence: 99%

Current understanding of von Willebrand's disease in women – some answers, more questions

Kouides

2006

Haemophilia

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Considerable progress has been made in the past decade in describing the obstetrical and gynaecological aspects of von Willebrand's disease (VWD). In addition, epidemiological studies have established an approximately 11-16% prevalence of the laboratory diagnosis of VWD in women presenting with menorrhagia. However, it is not established presently whether an upfront VWD screening should be a part of the standard evaluation of menorrhagia. This is because it is presently not known whether therapy in the VWD patient tailored specifically for VWD will appreciably alter the natural history of menorrhagia compared with the non-VWD menorrhagia patient. There are also subtleties involved in securing the diagnosis of VWD in women presenting with menorrhagia in terms of fluctuation of von Willebrand factor (VWF) levels vis-à-vis the menstrual cycle and the potential impact of oral contraceptive on VWF levels. Regarding management of VWD-related menorrhagia, pending ongoing comparative trials of intranasal desmopressin (DDAVP), tranexamic acid, oral contraceptive and the levonorgestrel intrauterine device, specific recommendations cannot be made presently regarding the superiority of one intervention compared with the other. The management of VWD-related postpartum haemorrhage is also an area of active debate in terms of 'best practice' in type 1 (? prophylactic DDAVP), type 2 [? expectant management if factor VIII:C (FVIII:C) level normalizes] and type 3 patients (? intensity and duration of infusional therapy with a VWF-containing plasma-derived FVIII concentrate). This review summarizes the present state of knowledge and highlights numerous questions for future study based on our present understanding of VWD in women.

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Hemostasis profile in women taking low-dose oral contraceptives

Cited by 56 publications

References 9 publications

von Willebrand's disease and menorrhagia: Prevalence, diagnosis, and management

von Willebrand's disease and menorrhagia: Prevalence, diagnosis, and management

The diagnosis of von Willebrand disease: a guideline from the UK Haemophilia Centre Doctors’ Organization

Current understanding of von Willebrand's disease in women – some answers, more questions

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