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Bleeding Disorders and Women
Because of obstetric and gynecological issues in particular, women who are symptomatic carriers of hemophilia and women with von Willebrand disease or other bleeding disorders have special issues:

• Prolonged menstrual bleeding and prolonged bleeding after childbirth or miscarriage can be a problem. Long, heavy menstrual flows often lead to low iron levels. Therefore, women with bleeding disorders should routinely be tested for anemia.

• To help control menstrual bleeding in some cases, doctors may prescribe birth control pills or Stimate nasal spray. These will boost factor VIII and von Willebrand factor levels.

• If birth control pills or Stimate are not effective, more extreme procedures might have to be considered. These might include a D&C (dilation and curettage, a scraping of the lining of the uterus) or hysterectomy (surgical removal of the uterus).

Medical and surgical options should be discussed by a woman and her doctor. Decisions about what path to pursue should be based on personal preference, family planning goals and severity of bleeding problems.

During pregnancy, levels of factors VIII and IX and von Willebrand factor usually increase in women with bleeding disorders. For women with von Willebrand disease, postpartum (after-delivery) bleeding may be treated with desmopressin acetate or a von Willebrand-containing concentrate. A woman with a bleeding disorder who becomes pregnant should see an obstetrician as soon as possible. This will ensure that the doctor can work with the local hemophilia treatment center to provide pre- and postnatal care for the woman and her fetus and testing of the baby.

Miscarriages and abortions, even early in the course of a pregnancy, can result in prolonged bleeding for women with bleeding disorders. Women with bleeding disorders who know or think they are miscarrying, or who are choosing to end a pregnancy, should promptly seek medical care. It's better to obtain this treatment as soon as a woman learns she is pregnant.

For more information on "Women and Bleeding Disorders," visit NHF's Project Red Flag Web site.

The information contained on the NHF web site is provided for your general information only. NHF does not give medical advice or engage in the practice of medicine. NHF under no circumstances recommends particular treatment for specific individuals and in all cases recommends that you consult your physician or local treatment center before pursuing any course of treatment.
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