Assessment of menstrual blood loss and gynaecological problems in patientswith inherited bleeding disorders

Menstrual blood loss and gynaecological problems in patients with inherited bleeding disorders were assessed in this study. One hundred and sixteen wo men, including 66 with von Willebrand's disease (vWD), 30 carriers of haemo philia and 20 with factor XI (FXI) deficiency were interviewed and their gy naecological history obtained. Their case records were also reviewed and me nstrual loss was objectively assessed using a pictorial blood assessment ch art (PBAC). Comparison with an age-matched control group (69 women) was per formed. Menorrhagia (PBAC score > 100) was confirmed in 74%, 57% and 59% of women with vWD, carriers of haemophilia and FXI deficiency, respectively, in comparison with 29% in the control group (P = 0.001). PBAC scores were h igher in vWD patients with a von Willebrand factor activity (vWF:Ac) of I 3 0 IU dL(-1) compared to those with higher levels, but the difference was no t statistically significant. However, there was no relation between PBAC sc ore and the severity of the disease in FXI deficient patients and carriers of haemophilia. Duration of menstruation was significantly longer (P = 0.00 1) and episodes of flooding was significantly more common (P = 0.001) in pa tients with inherited bleeding disorders compared to the control group. How ever, there was no difference in the passage of clots during menstruation. Forty-seven per cent of patients with inherited bleeding disorders had cons ultations with their family practitioner or gynaecologist for menorrhagia, 36% had medical treatment and 27% had surgical procedures, including 10 hys terectomies. Post-operative bleeding followed in four out of 28 cases of hy steroscopy and/or dilatation and curettage. Bleeding complications followin g hysterectomy were reported in five out of 10 patients. In conclusion, men orrhagia is a common and major problem in patients with inherited bleeding disorders, especially vWD. Increased awareness among gynaecologists and hae matologists of the high prevalence of menorrhagia and the treatment options available is necessary for optimal management of these patients. Appropria te preoperative assessment and haemostatic control during any gynaecologica l procedure, however minor, and in collaboration with the local haemophilia centre is essential to minimize risks of haemorrhagic complications.