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
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.