Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel

James, Andra H.; Kouides, Peter A.; Abdul‐Kadir, Rezan; Edlund, Måns; Federici, Augusto B.; Halimeh, Susan; Kamphuisen, Pieter Willem; Konkle, Barbara A.; Martínez-Pérez, Óscar; McLintock, Claire; Peyvandi, Flora; Winikoff, Rochelle

doi:10.1016/j.ajog.2009.04.024

Cited by 141 publications

(132 citation statements)

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“…Menorrhagia is a frequent presentation in females. VWD has been found in 15-20 % of females with menorrhagia [15]. Routine investigation for VWD in women with isolated menorrhagia is not recommended unless it is associated with additional bleeding symptoms or there is severe menstrual bleeding at menarche [16].…”

Section: Bleeding Historymentioning

confidence: 99%

Von Willebrand Disease: Range of the Disease, and Management

Fernández

Alarcón

2013

Curr Pediatr Rep

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Section: Bleeding Historymentioning

confidence: 99%

Von Willebrand Disease: Range of the Disease, and Management

Fernández

Alarcón

2013

Curr Pediatr Rep

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“…It might be excessively heavy or light, prolonged, frequent, or random. 10,11 Endometerial carcinoma was detected in 18% of hysterectomy specimens in cases of abnormal uterine bleeding in a local study conducted at Rawalpindi.…”

Section: Introductionmentioning

confidence: 99%

Endometrial Carcinoma; Incidence in Women With Abnormal Uterine Bleeding

Khan

Yasmeen

Riaz

2015

TPMJ

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ABSTRACT… Background: Bleeding from the reproductive tract in women is a naturally occurring event, generally the result of menstruation and childbirth, and is not associated with a bleeding disorder in most cases. Dysfunctional uterine bleeding is the most common reason for women to undergo an interventional gynecologic procedure. The major task of the clinician is to exclude endometrial carcinoma in women and to identify organic pathology in order to manage it effectively. Objective. To determine the incidence of endometrial carcinoma in women with abnormal uterine bleeding. Study Design: Cross sectional study. Setting. Department of Obstetrics and Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan. Duration of study: Six months (16 th February 2013 to 15 th August 2013). Material and method: One hundred and sixteen women with complaint of abnormal uterine bleeding, meeting the inclusion criteria were selected. All the patients were undergone endometrial sampling and assessment of endometrial thickness was done which was confirmed by endometrial biopsy to evaluate endometrial pathologies. The collected data was noted on pre-designed proforma. Results: The mean age was 42.07 years. According to parity, 56 women (48.2%) have 1-4 parity, 48 women (41.4%) have 5-8 parity and 12 women (10.4%) have 9-14 parity. The mean duration of dysfunctional uterine bleeding was 14.64±7.87 months. Six women (5.2%) have endometrial carcinoma while 110 women (94.8%) have no endometrial carcinoma. Conclusion: This study thus proved that in our setup the incidence of endometrial carcinoma is very high. So every patient with abnormal uterine bleeding should undergo endometrial biopsy to rule out endometrial carcinoma. Key words:Endometrial carcinoma, Dysfunctional uterine bleeding, Menorrhagia. Article Citation: Khan SM, Yasmeen F, Riaz A. Endometrial carcinoma; incidence in women with abnormal uterine bleeding.

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“…Although testing appears to be most sensitive during menstruation when coagulation factor levels, most notably VWF and FVIII, are potentially at their lowest, 13 testing should not be delayed to coincide with menstruation, but repeat testing during menses should be considered if initial VWF levels are at the lower limit of normal. 1 Patients should not be removed from hormonal contraception to permit testing. 1 Nonetheless, it should be remembered that women with mild type 1 VWD may have normal results when combined hormonal contraceptives are used, estrogens being sometimes, but not always, associated with normalization of coagulation test results.…”

mentioning

confidence: 99%

“…1 Patients should not be removed from hormonal contraception to permit testing. 1 Nonetheless, it should be remembered that women with mild type 1 VWD may have normal results when combined hormonal contraceptives are used, estrogens being sometimes, but not always, associated with normalization of coagulation test results.…”

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Heavy menstrual bleeding: work-up and management

James

2016

Hematology

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Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects~90% of women with an underlying bleeding disorder and~70% of women on anticoagulation. HMB can be predicted on the basis of clots of ‡1 inch diameter, low ferritin, and "flooding" (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patient's history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation. The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, and may even be life-saving when used to correct an abnormality of coagulation. Learning Objectives• Identify 3 clinical features that correlate with true HMB • Name the first-line therapies for HMB Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects~90% of women with an underlying bleeding disorder 1 and~70% of women on anticoagulation. [2][3][4][5] It is a condition hematologists are expected to understand and, in some cases, to help manage. This paper will describe normal menstruation, define HMB, summarize the causes of HMB, describe the gynecologic and hematologic evaluation of HMB, and discuss the hormonal, surgical, and hemostatic management of HMB. Normal menstruationThe following description of normal menstruation applies to all reproductive-age women, including adolescents. If fertilization (pregnancy) does not occur, the menstrual cycle begins with the sloughing or shedding of the lining of the uterus (ie, the endometrium). Then, under the influence of estrogen from ovarian follicles, the endometrium increases in thickness due to the development of glands and blood vessels. Approximately mid-cycle (in a normal cycle), ovulation occurs. The dominant ovarian follicle undergoes a process described as luteinization, becomes a corpus luteum, and secretes progesterone. Under the influence of progesterone, the endometrial glands mature and become secretory. In the absence of fertilization, the endometrial vessels constrict and the newly developed portion of the endometrium, including the new glands and blood vessels, becomes ischemic and starts to slough, thereby beginning another cycle (Figure 1).

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Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel

Cited by 141 publications

References 53 publications

Von Willebrand Disease: Range of the Disease, and Management

Von Willebrand Disease: Range of the Disease, and Management

Endometrial Carcinoma; Incidence in Women With Abnormal Uterine Bleeding

Heavy menstrual bleeding: work-up and management

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