women

Women and von Willebrand disease

Menorrhagia and pregnancy-related bleeding are common problems in women with VWD.1

Menorrhagia

For many women, menorrhagia is one of the first signs of VWD.2 Often, periods will last for weeks or even months. Yet this symptom frequently goes unrecognized.

  • In some cases, a woman thinks such bleeding is "normal" because her mother and/or sisters or other female relatives also have very heavy menstrual periods.
  • In other cases, menorrhagia is misdiagnosed as a gynecologic problem.3

Some of the symptoms of heavy blood loss during menstruation are3-5:

  • Using more than 30 pads/tampons for a typical menstrual cycle
  • Changing a pad/tampon every 30 minutes to 2 hours on the heaviest day of a period
  • Needing to use a pad and tampon together
  • Presence of clots greater than 1 inch in diameter
  • Frequently staining through clothes/nightclothes
  • Severe cramps (called dysmenorrhea)
  • Decreased red blood cells (called anemia) caused by menstrual bleeding that requires iron therapy or transfusion

Pregnancy-Related Bleeding

During pregnancy, levels of VWF and FVIII increase, giving women with VWD some protection from bleeding.6  But within days to weeks after delivery (or miscarriage or abortion), levels of both clotting factors fall to where they were before pregnancy. As a result, about 60% of women with VWD experience excessive blood loss after childbirth (called postpartum hemorrhage).1

Women with VWD certainly can and do have healthy babies. However, it is important to consult a hematologist early in the pregnancy so that the bleeding disorder can be closely monitored.




women_references

References:

  1. Kirtava A, Drews C, Lally C, Dilley A, Evatt B. 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(3):292-297.
  2. Nichols WL, Hultin MB, James AH, et al. von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia. 2008;14(2):171-232.
  3. Paper R. Gynecological complications in women with bleeding disorders. World Federation of Hemophilia. June 2004;no. 5.
  4. Kouides PA. Menorrhagia from a haematologist's point of view. Part I: initial evaluation. Haemophilia. 2002;8(3):330-338.
  5. NHLBI. National Heart, Lung, and Blood Institute. The diagnosis, evaluation, and management of von Willebrand disease. Available at: http://www.nhlbi.nih.gov/guidelines/vwd/vwd.pdf. Accessed August 5, 2013.
  6. Kujovich JL. Von Willebrand disease and pregnancy. J Thromb Haemost. 2005;3:246-253.

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