von Willebrand disease and bleeding in women

Menorrhagia is a common health problem in women, particularly those with bl eeding disorders. Little is known about the course of menorrhagia or other bleeding symptoms in women with the most common congenital bleeding disorde r, von Willebrand disease (vWD). We determined the prevalence of menorrhagi a, bleeding symptoms and coagulation abnormalities associated with vWD, inc luding factor VIII activity, von Willebrand factor (vWF) antigen, ristoceti n cofactor and bleeding time (BT), on a cohort of 38 females with type 1 vW D referred for diagnosis and medical care. Menorrhagia was the most common bleeding symptom in females with vWD, occurring in 93.1% of adult women. Me norrhagia was also the most common initial bleeding symptom, occurring in 5 3.1% of adult women in all of whom it began at menarche, median 14 years of age. There was a delay from initial bleeding symptoms, at median age 12 ye ars, to diagnosis, at median age 16 years, P=0.0049. Although 94% undergoin g surgery had previous bleeding, a vWD diagnosis was known preoperatively i n only 6.2%, resulting in potentially preventable bleeding. In summary, men orrhagia is the most common bleeding symptom in females with vWD and begins at menarche. Obtaining a personal and family bleeding history promotes ear ly diagnosis, potentially prevents postoperative bleeding, and improves the health of women with vWD.