Read Female Factors: information for young women with bleeding disorders for updated info on VWD in women and girls
Heavy bleeding with menstrual periods (menorrhagia) is a common symptom of VWD for women and girls. It may involve:
Heavy menstrual bleeding can lead to anaemia (low red blood cell count/low blood iron levels), with symptoms of fatigue, paleness, lack of energy and shortness of breath.
Some women and girls with VWD also experience:
Although these can be symptoms of VWD, they can also be symptoms of a gynaecological disorder, so it is important to consult a gynaecologist.
If you are a woman or girl with VWD, a holistic or comprehensive care approach to your health care can help you to achieve better health and quality of life. Specialist gynaecological care over your lifetime is important to manage any gynaecological issues that occur. These may not be related to VWD, but in some cases VWD may make the bleeding problems worse.
Ideally your medical care team should work together on your health care and should include:
With diagnosis and appropriate treatment, these problems can be dramatically reduced and sometimes even eliminated. Women who have menorrhagia or abnormal vaginal bleeding need a full gynaecologic consultation before treatment to understand any gynaecological issues.
Bleeding disorder treatments for heavy menstrual bleeding include:
Women with bleeding disorders should avoid taking non-steroidal anti-inflammatory drugs for period pain, unless prescribed by a doctor with expertise in VWD (ie, Naprosyn/naproxen, ibuprofen, etc – these have many brand names; ask your local pharmacist to check for you). These medicines can interfere with the way platelets promote clotting and cause bleeding to go on for longer.
Generally, treatment options with medication will be exhausted before considering surgery such as hysterectomy (surgical removal of the uterus) or procedures such as endometrial ablation, where the lining of the uterus is destroyed to reduce menstrual blood loss. Surgery and some procedures have their own risk of bleeding complications for women with VWD.
However, some women with VWD may need to have gynaecological surgery or procedures for other reasons. If this happens, it is important that this is managed in a team, with discussion between the woman, the Haemophilia Centre and the gynaecologist and/or surgeon.
Puberty: menstrual bleeding can be especially heavy when a girl first starts having periods. When there is a family history of VWD or it is known that she has VWD, a girl should be followed closely by her medical team during puberty and may need treatment if she has heavy bleeding.
Sexual intercourse: some women with VWD may experience bleeding if there are small tears in their vagina after sexual intercourse. This can happen during their first sexual experience when the hymen is broken. It can also occur after childbirth and menopause when the vaginal wall may be thinner and dryer due to a drop in oestrogen levels – oestrogen creams for the vaginal wall and/or lubricants can help with this.
Pregnancy and childbirth: most women with VWD do not have a problem with delivering a healthy baby. Pregnancy can cause blood levels of VWF to increase, decreasing the likelihood of bleeding complications during pregnancy and delivery. However, this needs to be monitored as women with VWD can have heavy bleeding for an extended period after delivery when their factor levels return to their usual levels.
To minimise the chances of complications:
Menopause: When a woman begins menopause, her body’s erratic hormone regulation can increase her risk of unpredictable and heavy menstrual bleeding. However, for some women with VWD, levels of VWF rise as they age and normalise so that bleeding problems reduce. Keeping a close relationship with her gynaecologist in the years before menopause will help a woman with VWD be prepared to manage any problems that might occur.
To understand more about these issues and options and how they relate to your specific situation, talk to your specialist Haemophilia Centre team.
Resources for women with bleeding disorders:
Source: Haemophilia Foundation Australia. A guide for people living with von Willebrand disorder. Melbourne: HFA, 2010.
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