Management of heavy menstrual bleeding in women with bleeding disorders in a tertiary care center

Shikha Kuthiala; Julie Grabell; Nicole Relke; Wilma M Hopman; Mariana Silva; Mary Anne Jamieson; Paula James

doi:10.1016/j.rpth.2023.100119

Management of heavy menstrual bleeding in women with bleeding disorders in a tertiary care center

Res Pract Thromb Haemost. 2023 Mar 13;7(3):100119. doi: 10.1016/j.rpth.2023.100119. eCollection 2023 Mar.

Authors

Shikha Kuthiala^{1

2}, Julie Grabell³, Nicole Relke^{1

3

4}, Wilma M Hopman⁵, Mariana Silva^{1

6}, Mary Anne Jamieson^{1

7}, Paula James^{1

3

8}

Affiliations

¹ School of Medicine, Queen's University, Ontario, Canada.
² Department of Obstetrics & Gynecology, McMaster University, Ontario, Canada.
³ Department of Medicine, Queen's University, Ontario, Canada.
⁴ Department of Hematology, University of Toronto, Ontario, Canada.
⁵ Department of Public Health Sciences, KHSC Research Institute, Queen's University, Ontario, Canada.
⁶ Department of Pediatrics, Queen's University, Ontario, Canada.
⁷ Department of Obstetrics & Gynecology, Queen's University, Ontario, Canada.
⁸ Department of Pathology and Molecular Medicine, Queen's University, Ontario, Canada.

Abstract

Background: Heavy menstrual bleeding (HMB) affects a significant number of women with bleeding disorders and has a negative impact on their quality of life.

Objective: This retrospective study examined the management of patients with inherited bleeding disorders who used medical treatments, alone or in combination, for HMB.

Methods: Chart review was performed on women attending the Women with Bleeding Disorders Clinic in Kingston, Ontario, between 2005 and 2017. Data collected included patient demographics, the reason for presentation and diagnosis, medical history, treatments, and patient satisfaction.

Results: One hundred nine women were included in this cohort. Of these, only 74 (68%) were satisfied with medical management, and only 18 (17%) with first-line therapy. Treatments included combined contraceptives (oral pill, transdermal patch, and vaginal ring), progesterone-only pills, tranexamic acid, 52-mg levonorgestrel intrauterine system (LIUS), depomedroxyprogesterone acetate, and desmopressin, either alone or in combination. Satisfactory control of HMB occurred most often with the LIUS.

Conclusion: In this cohort, managed in a tertiary care Women with Bleeding Disorders Clinic, only 68% of patients had successful control of HMB with medical treatment, and a minority were satisfied with first-line therapy. These data clearly highlight the need for additional research, including treatment approaches and novel therapies for this population.

Keywords: hemophilia A; patient satisfaction; quality of life; tranexamic acid; von Willebrand disease.