Menorrhagia from a haematologist's point of view. Part I: initial evaluation

Abstract

The evaluation of menorrhagia should no longer be solely the task of the gynaecologist. In women with ovulatory bleeding (regular cycles), the prevalence of von Willebrand disease (vWD) in about 15% of these, as well as disorders of platelet function and fibrinolysis causing menorrhagia, warrants an active role by the haematologist. Initial intake should include documentation of menorrhagia by the pictorial chart assessment of menstrual flow. Baseline characteristics of menstrual flow should also be documented, including the frequency of changing the sanitary pad on the heaviest day, use of more than one sanitary pad at a time, number of days lost from school/work and the impact of menses on various quality-of-life parameters. Menorrhagia since menarche, a past history of surgical- and/or dental-related bleeding and a past history of postpartum haemorrhage are items of the bleeding symptom audit that appear in part to predict vWD in women with menorrhagia. Epistaxis and easy bruising do not appear to be clearly discriminatory symptoms. Initial testing should include the complete blood cell count, prothrombin time, activated partial thromboplastin time, iron profile, serum creatinine, thyroid stimulating hormone level, factor VIII level, vWF antigen, ristocetin cofactor and platelet aggregation studies. Additional haemostatic studies may also include a factor XI level and euglobulin clot lysis time. This extensive medical evaluation should assure both the patient and the gynaecologist that the possibility of an underlying haemostatic disorder has been thoroughly investigated, to avoid the patient undergoing further costly procedures and surgical interventions if an underlying haemostatic disorder remains unrecognized.

Endometriosis Is Associated With Prevalence of Comorbid Conditions in Migraine

“…Interference of menstrual periods with 7 activities of daily living was assessed using a Likert scale. 16,17 A scale of 0 to 10 was used with "0" being that menses "does not interfere" and "10" being that menses "completely interferes" with the daily activity. A global menstrual interference score was derived and examined for differences between the groups.…”

Management of menorrhagia in women with inherited bleeding disorders: general principles and use of desmopressin

“…The articles have provided primary data on the prevalence of VWD in adult women with menorrhagia, showing a prevalence ranging from 5% to 20% in five published studies [2]. On the basis of literature data, Kouides [34] estimates that from an ideal cohort of 100 women referred to a gynaecologist, on the average 50% will have an identifiable anatomical or functional cause, 15% will have subnormal VWF level, (35) 29 (83%) 6 (17%) Type 1 affected (44) 17 (39%) 27 (61%) Type 3 affected (10) 1 (10%) 9 (90%) Total 160 (68%) 75 (32%)…”

“…We have to balance the pros and cons of labelling an otherwise healthy subject with an inherited haemostatic disorder with the expected benefits reasonably related to more specific treatments or prevention of future bleeding in case of haemostatic challenges like parturition, toot extraction, or surgery. So far, given the lack of definitive outcome data, there is insufficient evidence to support the suggestion for routine haemostatic investigation in women presenting with apparently isolated menorrhagia [34][35][36]. Furthermore, available diagnostic tools are not sufficiently efficient.…”

Bleeding disorders among young women: A population‐based prevalence study

“…However, the subjective symptoms of a heavy menstruation are more common and occur in about 23–44% of the general female population 5. A high prevalence (13–17%) of von Willebrand disease (VWD) among women with menorrhagia has been found by several studies 7–10. The prevalence of platelet dysfunction (PDF) among menorrhagic women is also considered to be substantial 11 and could amount to 20–30% 12.…”