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

Abstract

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.

Structure and function of von Willebrand factor

“…Type II is accounts for 15-20% of VWD cases [117]. It is a variant of the disease with primarily qualitative defects of VWF (abnormal function) [118].…”

How I treat type 2 variant forms of von Willebrand disease

“…72,73 Midcycle pain due to bleeding into the corpus luteum after ovulation has been described in up to 49% of women with type 1 VWD. 74 Corpus luteum bleeding may extend into the broad ligament, and even cause massive hemoperitoneum requiring blood transfusion and surgical drainage. 75 In type 2 VWD women with mild gynecologic bleeding, we recommend the use of tranexamic acid to control menstrual losses.…”

Analysis of Causes of Menorrhagia in Patients With Normal Pelvic Pathology

“…Tests to diagnose von Willebrand's disease were suggested, this being the most common coagulopathy in menorrhagic patients. 7 but no patient could afford them. Wherever history, clinical examination, and routine tests indicated medical disorder, patients were referred to department of medicine to carry out special tests which helped us to diagnose different causes as shown in Table 4.…”