An international panel of experts in obstetrics, gynecology and hematology is publishing its findings on the clinical challenges of the diagnosis and management of menorrhagia (heavy, prolonged periods) in women with bleeding disorders in the July 2009 issue of the American Journal of Obstetrics & Gynecology. Since nearly 25% of women with menorrhagia have an underlying bleeding disorder and don’t know it, these findings could help them receive a diagnosis sooner. Currently, women wait an average of 16 years between onset of symptoms and diagnosis.
The consensus conference, first convened in 2007, brought together physicians from Europe, North America and elsewhere, to identify the difficulties faced by women with bleeding disorders and to establish recommendations and strategies for their healthcare providers.
The most common bleeding disorder in women is von Willebrand disease (VWD), which results from defective or deficient von Willebrand factor, a clotting protein. The panelists established more than a dozen symptoms that could indicate the presence of VWD or another bleeding disorder in female patients. These symptoms include:
- menorrhagia since puberty,
- family history of a bleeding disorder,
- personal history of a bleeding disorder,
- and concurrent symptoms such as recurrent nosebleeds, bruising without injury, minor wound bleeding, and excessive or prolonged bleeding after a tooth extraction.
The group also discussed therapy options, including the use of antifibrinolytic agents (tranexamic acid, aminocaproic acid), desmopressin (DDAVP injection, Stimate) and products containing von Willebrand factor and factor VIII.
The lead author of the article, “Von Willebrand Disease and Other Bleeding Disorders in Women: Consensus on Diagnosis and Management from an International Expert Panel,” is Andra James, MD, from the Women’s Hemostasis and Thrombosis Clinic at Duke University Medical Center in Durham, NC. James is a member of the National Hemophilia Foundation’s Medical and Scientific Advisory Council (MASAC). Peter A. Kouides, MD, Medical and Research Director of the Mary M. Gooley Hemophilia Center at Rochester General Hospital (NY), is a co-author and MASAC member.
“Obstetricians and gynecologists should be aware of bleeding disorders such as VWD, rare bleeding disorders and platelet disorders, which remain underdiagnosed in women with menorrhagia and potentially in other cases of abnormal bleeding such as postpartum hemorrhage. Clues, including a family or personal history of bleeding events, should provoke suspicion of an underlying bleeding disorder. Responding to these clues facilitates collaboration among obstetrician–gynecologists and hematologists that could lead to a decrease in the diagnosis of ‘idiopathic’ menorrhagia and allow more effective management of bleeding events,” explained the authors.
In suspected cases, the experts recommended testing a woman’s platelet number and function, and performing a coagulation factor profile. Repeated tests would confirm the diagnosis, said the authors. The provider partnership could also help women with menorrhagia or post-partum bleeding avoid unnecessary, and sometimes dangerous, hysterectomies.
Source: AlphaGalileo news release dated June 2, 2009