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19 - Coagulation defects as a cause for menstrual disorders

Published online by Cambridge University Press:  01 February 2010

By
Albert J. Phillips M.D., F.A.C.O.G.
Edited by
Rodger L. Bick ,
Eugene P. Frenkel ,
William F. Baker  and
Ravi Sarode
Albert J. Phillips M.D., F.A.C.O.G.
Affiliation:
Clinical Professor of Obstetrics and Gynecology, University of Southern California, School of Medicine, 1301 20th Street, Suite 270, Santa Monica, California 90404, USA
Rodger L. Bick
Affiliation:
University of Texas Southwestern Medical Center, Dallas
Eugene P. Frenkel
Affiliation:
University of Texas Southwestern Medical Center, Dallas
William F. Baker
Affiliation:
University of California, Los Angeles
Ravi Sarode
Affiliation:
University of Texas Southwestern Medical Center, Dallas
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Summary

Menorrhagia

Introduction

Normal menstruation occurs every 21–35 days lasting on average 7 days. Normal blood loss is between 25 and 69 ml per cycle. Menstrual abnormalities can be characterized by their flow and regularity. Menorrhagia is defined as bleeding of over 80 ml with menstruation. Menometrorrhagia is irregular heavy menstruations. Menstrual abnormalities can be caused by multiple etiologies. These include gynecological abnormalities of the uterus, hormonal disorders, and systemic disorders. Prior reports have identified causes for excessive bleeding in only 50% of patients. The estimated prevalence of menorrhagia in healthy women is between 9% and 14%. Menorrhagia has been found to be a reliable predictor for coagulation and platelet disorders. In the absence of a readily identifiable cause, all adolescents with menorrhagia, especially those with anemia, should be examined for an undiagnosed coagulation defect.

Quality of life evaluations were shown to be poorer in all areas in women who had inherited bleeding disorders. As compared to controls, women with menorrhagia found that they accomplished less than they would like during menses, and their heavy flow limited their activities and the kind of work they could do. Forty-six percent of type 1 von Willebrand disease (VWD) patients reported losing on average 4 days from work or school due to menorrhagia.

The gynecologist has a unique role in being the primary care giver, who generally is the first practitioner to whom the patient presents with menstrual bleeding problems.

Type
Chapter
Information
Hematological Complications in Obstetrics, Pregnancy, and Gynecology , pp. 570 - 588
Publisher: Cambridge University Press
Print publication year: 2006

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References

Hallberg, L., Hogdahl, A. M., Nilsson, L., et al. Menstrual blood loss – a population study. Variation at different ages and attempts to define normality. Acta Obstet. Gynecol. Scand., 1966; 45: 320–51.CrossRefGoogle ScholarPubMed
Oehler, M. K., Rees, M. C.Menorrhagia: an update. Acta Obstet. Gynecol. Scand., 2003; 82: 405–22.CrossRefGoogle ScholarPubMed
Eijkeren, M. A., Christianens, G. C., Sixma, J. J., et al. Menorrhagia: A review. Obstet. Gynecol. Surv., 1989; 44: 421.CrossRefGoogle ScholarPubMed
Edlund, M., Bolmback, M., Schoultz, B., et al. On the value of menorrhagia as a predictor for coagulation disorders. Am. J. Hematol., 1996; 53: 234–8.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Kadir, R. A., Sabin, C. A., Pollard, D., et al. Quality of life during menstruation in patients with inherited bleeding disorders. Haemophilia, 1998; 4: 836–41.CrossRefGoogle ScholarPubMed
Kouides, P. A., Phatak, P. D., Burkart, P., et al. Gynaecological and obstetrical morbidity in women with type I von Willebrand disease: results of a patient survey. Haemophilia, 2000; 6: 643–8.CrossRefGoogle ScholarPubMed
Markee, J. E.Menstruation in intraocular endometrial transplants in the Rhesus monkey. Contrib. Embryol., 1940; 28: 221–308.Google Scholar
Bartelmez, G. W.Histological studies on the menstruating mucous membrane of the human uterus. Contrib. Embryol., 1933; 24: 141–86.Google Scholar
Fauvel, F., Grant, M. E., Legrand, Y. J., et al. Interaction of blood platelets with a microfibrillar extract from adult bovine aorta: requirement for von Willebrand factor. Proc. Natl. Acad. Sci. USA, 1983; 80: 551–4.CrossRefGoogle ScholarPubMed
Christianes, G. C., Sixma, J. J., Haspels, A. A.Morphology of haemostasis in menstrual endometrium. Br. J. Obstet. Gynaecol., 1980; 87: 425–39.CrossRefGoogle Scholar
Fraser, I. S., McCarron, G., Markham, R.A preliminary study of factors influencing perception of menstrual blood loss volume. Am. J. Obstet. Gynecol., 1984; 149: 788–93.CrossRefGoogle ScholarPubMed
Higham, J. M., O'Brien, P. M., Shaw, R. W.Assessment of menstrual blood loss using a pictorial chart. Br. J. Obstet. Gynaecol., 1990; 97: 734–9.CrossRefGoogle ScholarPubMed
Reid, P. C., Coker, A., Coltart, R.Assessment of menstrual blood loss using a pictorial chart: a validation study. Br. J. Obstet. Gynaecol., 2000; 107: 320–2.CrossRefGoogle ScholarPubMed
Wyatt, K. M., Dimmock, P. W., Walker, T. J., et al. Determination of total menstrual blood loss. Fertil. Steril., 2001; 76: 125–31.CrossRefGoogle ScholarPubMed
Dilley, A., Drews, C., Lally, C., et al. A survey of gynecologists concerning menorrhagia: perceptions of bleeding disorders as a possible cause. J. Womens Health Gend. Based Med., 2002; 11: 39–44.CrossRefGoogle ScholarPubMed
Kadir, R. A., Aledort, L. M.Obstetrical and gynaecological bleeding: a common presenting symptom. Clin. Lab. Haematol., 2000; 22 (Suppl. 1): 12–6; discussion, 30–2.CrossRefGoogle ScholarPubMed
Ellis, M. H., Beyth, Y.Abnormal vaginal bleeding in adolescence as the presenting symptom of a bleeding diathesis. J. Pediatr. Adolesc. Gynecol., 1999; 12: 127–31.CrossRefGoogle ScholarPubMed
Werner, E. J., Broxson, E. H., Tucker, E. L., et al. Prevalence of von Willebrand disease in children: a multiethnic study. J. Pediatr., 1993; 123: 893–8.CrossRefGoogle ScholarPubMed
Rodeghiero, F., Castaman, G., Dini, E.Epidemiological investigation of the prevalence of von Willebrand's disease. Blood, 1987; 69: 454–9.Google ScholarPubMed
Ruggeri, Z. M.Mechanisms initiating platelet thrombus formation. Thromb. Haemost., 1997; 78: 611–16. Erratum in: Thromb. Haemost., 1997; 78: 1304.Google ScholarPubMed
Kadir, R. A., Economides, D. L., Sabin, C. A., et al. Assessment of menstrual blood loss and gynaecological problems in patients with inherited bleeding disorders. Haemophilia, 1999; 5: 40–8.CrossRefGoogle ScholarPubMed
Goodman-Gruen, D., Hollenbach, K.The prevalence of von Willebrand disease in women with abnormal uterine bleeding. J. Womens Health Gend. Based Med., 2001; 10: 677–80.CrossRefGoogle ScholarPubMed
Shankar, M., Lee, C. A., Sabin, C. A., et al. Von Willebrand disease in women with menorrhagia: a systematic review. Br. J. Obstet. Gynaecol., 2004; 111: 734–40.CrossRefGoogle ScholarPubMed
Federici, A. B., Mannucci, P. M.Advances in the genetics and treatment of von Willebrand disease. Curr. Opin. Pediatr., 2002; 14: 23–33.CrossRefGoogle ScholarPubMed
Kadir, R. A., Economides, D. L., Sabin, C. A., et al. Variations in coagulation factors in women: effects of age, ethnicity, menstrual cycle and combined oral contraceptive. Thromb. Haemost., 1999; 82: 1456–61.CrossRefGoogle ScholarPubMed
Edlund, M., Blomback, M., Schoultz, B., et al. On the value of menorrhagia as a predictor for coagulation disorders. Am. J. Hematol., 1996; 53: 234–8.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Onundarson, P. T., Gudmundsdottir, B. R., Arnfinnsdottir, A. V., et al. Von Willebrand factor does not vary during normal menstrual cycle. Thromb. Haemost., 2001; 85(1): 183–4.Google Scholar
Werner, E. J., Abshire, T. C., Giroux, D. S., et al. Relative value of diagnostic studies for von Willebrand disease. J. Pediatr., 1992; 121: 34–8.CrossRefGoogle ScholarPubMed
Coccia, M. R., Barnes, H. V.Hypothyroidism and acquired von Willebrand disease. J. Adolesc. Health, 1991; 12: 152–4.CrossRefGoogle ScholarPubMed
Blesing, N. E., Hambley, H., McDonald, G. A.Acquired von Willebrand's disease and hypothyroidism: report of a case presenting with menorrhagia. Postgrad. Med. J., 1990; 66: 474–6.CrossRefGoogle ScholarPubMed
Mannucci, P. M.Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years. Blood, 1997; 90: 2515–21.Google ScholarPubMed
Rodeghiero, F., Castaman, G., Mannucci, P. M.Prospective multicenter study on subcutaneous concentrated desmopressin for home treatment of patients with von Willebrand disease and mild or moderate hemophilia A. Thromb. Haemost., 1996; 76(5): 692–6.Google ScholarPubMed
Siegel, J. E., Kouides, P. A.Menorrhagia from a haematologist's point of view. Part II: management. Haemophilia, 2002: 8: 339–47.CrossRefGoogle ScholarPubMed
Federici, A. B., Mazurier, C., Berntorp, E., et al. Biologic response to desmopressin in patients with severe type 1 and type 2 von Willebrand disease: results of a multicenter European study. Blood, 2004; 103: 2032–8.CrossRefGoogle ScholarPubMed
Castaman, G., Lattuada, A., Mannucci, P. M., et al. Factor VIII: C increases after desmopressin in a subgroup of patients with autosomal recessive severe von Willebrand disease. Br. J. Haematol., 1995; 89: 147–51.CrossRefGoogle Scholar
Alperin, J. B.Estrogens and surgery in women with von Willebrand's disease. Am. J. Med., 1982; 73: 367–71.CrossRefGoogle ScholarPubMed
David, J. L., Gaspard, U. J., Gillain, D., et al. Hemostasis profile in women taking low-dose oral contraceptives. Am. J. Obstet. Gynecol., 1990; 163: 420–3.CrossRefGoogle ScholarPubMed
Beller, F. K., Ebert, C.Effects of oral contraceptives on blood coagulation. A review. Obstet. Gynecol. Surv., 1985; 40(7): 425–36.CrossRefGoogle ScholarPubMed
Foster, P. A.The reproductive health of women with von Willebrand disease unresponsive to DDAVP: results of an international survey. On behalf of the Subcommittee on von Willebrand Factor of the Scientific and Standardization Committee of the ISTH. Thromb. Haemost., 1995; 74: 784–90.Google Scholar
Cederblad, G., Hahn, L., Korsan-Bengtsen, K., et al. Variations in blood coagulation, fibrinolysis, platelet function and various plasma proteins during the menstrual cycle. Haemostasis, 1977; 6: 294–302.Google ScholarPubMed
Ong, Y. L., Hull, D. R., Mayne, E. E.Menorrhagia in von Willebrand disease successfully treated with single daily dose tranexamic acid. Haemophilia, 1998; 4: 63–5.CrossRefGoogle ScholarPubMed
Mohri, H.High dose of tranexamic acid for treatment of severe menorrhagia in patients with von Willebrand disease. J. Thromb. Thrombolysis, 2002; 14: 255–7.CrossRefGoogle ScholarPubMed
Dunn, C. J., Goa, K. L.Tranexamic acid: a review of its use in surgery and other indications. Drugs, 1999; 57: 1005–32.CrossRefGoogle Scholar
Vermylen, J., Verhaegen-Declercq, M. L., Verstraete, M., et al. A double blind study of the effect of tranexamic acid in essential menorrhagia. Thromb. Diath. Haemorrh., 1968; 20: 583–7.Google ScholarPubMed
Bonnar, J., Sheppard, B. L.Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid. BMJ, 1996; 313: 579–82.CrossRefGoogle ScholarPubMed
Eijkeren, M. A., Christiaens, G. C., Scholten, P. C., et al. Menorrhagia. Current drug treatment concepts. Drugs, 1992; 43: 201–9.Google ScholarPubMed
Ong, Y. L., Hull, D. R., Mayne, E. E.Menorrhagia in von Willebrand disease successfully treated with single daily dose tranexamic acid. Haemophilia, 1998; 4: 63–5.CrossRefGoogle ScholarPubMed
Mehta, B. C., Parekh, D. S.Epsilon-amino-caproic acid in the treatment of menorrhagia. J. Postgrad. Med., 1977; 23: 121–3.Google ScholarPubMed
Nitu-Whalley, I. C., Lee, C. A.Acquired von Willebrand syndrome – report of 10 cases and review of the literature. Haemophilia, 1999; 5: 318–26.CrossRefGoogle ScholarPubMed
Federici, A. B., Rand, J. H., Bucciarelli, P., et al. Acquired von Willebrand syndrome: data from an international registry. Thromb. Haemost., 2000; 84: 345–9.Google ScholarPubMed
Garewal, G., Ahluwalia, J.Platelet function disorders. Indian J. Pediatr., 2003; 70: 983–7.CrossRefGoogle ScholarPubMed
Saxena, R., Gupta, M., Gupta, P. K., et al. Inherited bleeding disorders in Indian women with menorrhagia. Haemophilia, 2003; 9: 193–6.CrossRefGoogle ScholarPubMed
Philipp, C. S., Dilley, A., Miller, C. H., et al. Platelet functional defects in women with unexplained menorrhagia. J. Thromb. Haemost., 2003; 1: 477–84.CrossRefGoogle ScholarPubMed
Markovitch, O., Ellis, M., Holzinger, M., et al. Severe juvenile vaginal bleeding due to Glanzmann's thrombasthenia: case report and review of the literature. Am. J. Hematol., 1998; 57: 225–7.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
DiMichele, D. M., Hathaway, W. E.Use of DDAVP in inherited and acquired platelet dysfunction. Am. J. Hematol., 1990; 33: 39–45.CrossRefGoogle ScholarPubMed
Bennett, J. S.Disorders of platelet function: evaluation and treatment. Cleve. Clin. J. Med., 1991; 58: 413–17.CrossRefGoogle ScholarPubMed
Bevan, J. A., Maloney, K. W., Hillery, C. A., et al. Bleeding disorders: A common cause of menorrhagia in adolescents. J. Pediatr., 2001; 138: 856–61.CrossRefGoogle ScholarPubMed
Smith, Y. R., Quint, E. H., Hertzberg, R. B.Menorrhagia in adolescents requiring hospitalization. J. Pediatr. Adolesc. Gynecol., 1998; 11: 13–15.CrossRefGoogle ScholarPubMed
Tomer, A., Schreiber, A. D., McMillan, R., et al. Menstrual cyclic thrombocytopenia. Br. J. Haematol., 1989; 71: 519–24.CrossRefGoogle ScholarPubMed
Bolton-Maggs, P. H., Patterson, D. A., Wensley, R. T., et al. Definition of the bleeding tendency in factor XI-deficient kindreds – a clinical and laboratory study. Thromb. Haemost., 1995; 73: 194–202.Google ScholarPubMed
Kadir, R. A., Economides, D. L., Lee, C. A.Factor XI deficiency in women. Am. J. Hematol., 1999; 60: 48–54.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Sapuri, M., Amoa, A. B., Kariwiga, G., et al. A case of factor V deficiency presenting as menorrhagia. P. N. G. Med. J., 1997; 40: 92–5.Google ScholarPubMed
Bennett, K., Daley, M. L., Pike, C.Factor V deficiency and menstruation: a gynecologic challenge. Obstet. Gynecol., 1997; 89: 839–40.CrossRefGoogle ScholarPubMed
White, B., O'Connor, H., Smith, O. P.Successful use of recombinant VIIa (Novoseven) and endometrial ablation in a patient with intractable menorrhagia secondary to FVII deficiency. Blood Coagul. Fibrinolysis 2000; 11: 155–7.CrossRefGoogle Scholar
Fasouliotis, S. J., Shushan, A.Severe menorrhagia due to factor VII deficiency successfully treated by thermal balloon endometrial ablation. J. Am. Assoc. Gynecol. Laparosc., 2003; 10: 116–18.CrossRefGoogle ScholarPubMed
Eijkeren, M. A., Christiaens, G. C., Haspels, A. A., et al. Measured menstrual blood loss in women with a bleeding disorder or using oral anticoagulant therapy. Am. J. Obstet. Gynecol., 1990; 162: 1261–3.CrossRefGoogle ScholarPubMed
Milad, M. P., Valle, R. F.Emergency endometrial ablation for life-threatening uterine bleeding as a result of a coagulopathy. J. Am. Assoc. Gynecol. Laparosc., 1998; 5: 301–3.CrossRefGoogle ScholarPubMed
Lee, C. A.Women and inherited bleeding disorders: menstrual issues. Semin. Hematol., 1999; 36: 21–7.Google ScholarPubMed
Nitu-Whalley, I. C., Griffioen, A., Harrington, C., et al. Retrospective review of the management of elective surgery with desmopressin and clotting factor concentrates in patients with von Willebrand disease. Am. J. Hematol., 2001; 66: 280–4.CrossRefGoogle ScholarPubMed
Kouides, P. A.Obstetric and gynaecological aspects of von Willebrand disease. Best Pract. Res. Clin. Haematol., 2001; 14: 381–99.CrossRefGoogle ScholarPubMed
Foster, P. A.A perspective on the use of FVIII concentrates and cryoprecipitate prophylactically in surgery or therapeutically in severe bleeds in patients with von Willebrand disease unresponsive to DDAVP: results of an international survey. On behalf of the Subcommittee on von Willebrand Factor of the Scientific and Standardization Committee of the ISTH. Thromb. Haemost., 1995; 74: 1370–8.Google Scholar
Federici, A. B., Mannucci, P. M.Optimizing therapy with factor VIII/von Willebrand factor concentrates in von Willebrand disease. Haemophilia., 1998; 4 (Suppl. 3): 7–10.CrossRefGoogle ScholarPubMed
Mannucci, P. M.Treatment of von Willebrand's Disease. N. Engl. J. Med., 2004; 351: 683–94.CrossRefGoogle ScholarPubMed
Mannucci, P. M., Chediak, J., Hanna, W., et al. Treatment of von Willebrand disease with a high-purity factor VIII/von Willebrand factor concentrate: a prospective, multicenter study. Blood, 2002; 99: 450–6.CrossRefGoogle ScholarPubMed
Biggs, R., Matthews, J. M.The treatment of haemorrhage in von Willebrand's disease and the blood level of factor VIII (AHG). Br. J. Haematol., 1963; 9: 203–14.CrossRefGoogle Scholar
Federici, A. B., Baudo, F., Caracciolo, C., et al. Clinical efficacy of highly purified, doubly virus-inactivated factor VIII/von Willebrand factor concentrate (Fanhdi) in the treatment of von Willebrand disease: a retrospective clinical study. Haemophilia, 2002; 8: 761–7.CrossRefGoogle ScholarPubMed

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