We have previously covered common causes of heavy menstrual periods–fibroids, polyps, & hormonal dysfunctional bleeding–as well as treatments. Von Willebrand disease (VWD) is the most frequent inherited bleeding disorder, effecting up to 1% of women. The condition results from a deficiency, dysfunction, or absence of a protein in the blood aptly named after its discoverer, von Willebrand factor (VWF). The most common symptom is heavy periods in 5–20% of these women.
A history of bleeding problems after medical or dental procedures, minor wounds, spontaneous or recurrent nosebleeds should raise the suspicion of a bleeding disorder. If so, then blood tests assessing the coagulation system should be obtained including VWF. Referral to a hematologist may assist in diagnosis and planning treatment strategies.
After diagnosis of VWD, the first choice of therapy for the management of heavy menstrual periods is birth control pills. The Mirena® IUD and endometrial ablation are also excellent options and can be obtained during an office visit. Desmopressin, is a synthetic version of the hormone vasopressin, which causes release of VWF stored in blood vessel walls and temporarily raises VWF for prophylactic use before minor procedures. It can be administered as a nasal spray. Treatments before major surgical procedures are beyond the scope of this newsletter.
A new medication, Tranexamic acid (Lysteda) was recently approved by the FDA as a non hormonal treatment for all women with heavy periods who decline the aforementioned interventions. It is contraindicated in women with history of blood clots in their legs or lungs. The medication is taken for 5 consecutive days beginning at onset of menstruation.
The World Health Organization estimates that 1 in 5 women will suffer with heavy menstrual bleeding at some point in their lives. As gynecologists we are often surprised how long afflicted women will endure heavy periods before seeking our help. Heavy periods are not a normal part of aging or occur after having babies. While hysterectomy (the removal of the uterus) is sometimes necessary, in the majority of cases there are many alternatives that are often successful.