Dr Shruti Prem Sudha, consultant haematologist discusses heavy menstrual bleeding in women. Is it a sign of a bleeding disorder?
One in five women has heavy menstrual bleeding which can have several causes, including blood disorders, hormonal imbalances, infection, gynaecological causes, or certain medications. In 12-20 per cent of women with heavy menstrual bleeding, the cause is an underlying bleeding disorder.
Women are more likely to notice symptoms of a bleeding disorder than men because of their menstrual period, however many women are unaware that they have a bleeding disorder despite having symptoms. Since bleeding disorders may run in families, a young girl may consider her heavy bleeding to be ‘normal’ because her mother’s bleeding patterns were similar.
Some FAQs about bleeding disorders in women.
- When is menstrual bleeding considered heavy?
Menstrual bleeding lasting for more than seven days is considered heavy. This is also true if a tampon or pad needs to be changed after less than two hours or if there are clots of an inch or larger. - What are the consequences of heavy menstrual bleeding?
It can cause you to feel tired or weak from anaemia and can lead to potential avoidable medical procedures, such as surgery to remove the uterus. - When should one suspect a bleeding disorder?
You should suspect that you have a bleeding disorder if you have heavy menstrual bleeding and any of the following:- Prolonged bleeding after dental procedures, surgery or childbirth.
- Nose bleeds longer than 10 minutes despite pressure or a nosebleed that required medical attention.
- Bleeding after injury for longer than 15 minutes or which restarts after a few days.
- Bruising with minor or no trauma, especially if you can feel a lump under the bruise.
- Blood in your stool for no apparent reason.
- Muscle or joint bleeding.
- Bleeding at immunisation sites.
- Bleeding requiring blood product transfusion.
- Bleeding severe enough to cause iron deficiency.
- If a family member has the above symptoms or has been diagnosed with a bleeding disorder.
- How can I confirm if my bleeding is due to a bleeding disorder?
If you have any of the above symptoms, it’s time to talk to a haematologist about a diagnosis. Your doctor will take a complete medical history including your family history, history of drugs which might increase risk of bleeding such as aspirin or pain killers, history of iron deficiency, and history of liver, kidney or blood diseases in the past. The doctor will also examine you for signs of bleeding such as skin bruises or anaemia. Heavy menstrual bleeding can also be a sign of a gynaecological disorder, hence you may also be referred for a gynaecological examination.To confirm the diagnosis, your doctor will order a combination of blood tests to check how quickly your blood clots, including levels of clotting factors and platelets in your blood. As many bleeding disorders are hereditary, if you are diagnosed with a bleeding disorder, other members of your family may have the same disease, and should consider getting tested. - What are the common bleeding disorders in women?
The most common bleeding disorder in women is von Willebrand disease (vWD), due to a lack of a protein needed for blood clotting, which occurs with a frequency of 1 in 1000 people. Platelet function disorders are also common, and these occur when the platelets in the blood, which are an important part of the clotting mechanism, do not function properly. Seventy five per cent of bleeding disorders are mild, and, though they cannot be cured, with proper diagnosis and management people can lead normal, active lives. It is important to remember that not all people with bleeding disorders have bleeding symptoms despite having the gene for the disease. However, they can still pass the disease on to their children. - Is there treatment for bleeding disorders?
Anyone who is responsible for a child with a bleeding disorder, like a teacher or school nurse, should be made aware about his or her condition. Your haematologist will decide on the treatment needed, based on the type of disorder and its severity. Many bleeding disorders are mild, and may need treatment only in the event of surgery, tooth extraction or accidents.
Some measures which are useful in the management of bleeding disorders are:
• Birth control pills or devices which can decrease bleeding from the uterus.
• Drugs preventing the breakdown of blood clots which can be used to stop bleeding after minor surgery, tooth extraction or an injury.
• In case of severe bleeding, replacement of the deficient clotting factor by transfusion may be needed.
- What about pregnancy in women with bleeding disorders?Women with bleeding disorders can have increased bleeding during and after delivery. Measures to minimise complications in pregnancy include:
- Consulting a haematologist and an obstetrician who specialises in high-risk pregnancies before you become pregnant.
- Using a centre that specialises in high-risk pregnancies which has a haematologist with expertise in bleeding disorders on the staff.
- Ask your doctor about measures to prevent serious blood loss, before any invasive procedure, such as amniocentesis.
- Meet with an anaesthesiologist prior to delivery, to review your choices for anaesthesia and to discuss measures to reduce bleeding risk.
With these precautions, most women with a bleeding disorder can have successful pregnancies.
Tips for people living with a bleeding disorder
It’s important that you try to prevent bleeding and stay healthy. You should:
- Avoid over-the-counter medicines that can affect blood clotting, including aspirin, and certain pain killers. Always check with your doctor before taking any new medicines.
- Tell any doctor or dentist you consult about your diagnosis. Maintain good oral hygiene in order to prevent dental problems.
- Exercise regularly and maintain a healthy weight in order to keep your muscles and joints healthy. Some safe exercises are swimming, biking and walking. Contact sports or lifting heavy weights are not safe activities in people with bleeding problems. Check with your doctor before starting any exercise programme.
Remember early diagnosis of a bleeding disorder is important to prevent complications, and to lead a normal, active life.
Call 17 812-000 or email [email protected]
