Effects of antiplatelet therapy on menstrual blood loss in reproductive-aged women: a systematic review

Eva K Kempers; Johanna A van der Zande; Paula M Janssen; Jérôme M J Cornette; Jolien W Roos-Hesselink; Marieke J H A Kruip

doi:10.1016/j.rpth.2023.102295

Effects of antiplatelet therapy on menstrual blood loss in reproductive-aged women: a systematic review

Res Pract Thromb Haemost. 2023 Dec 9;8(1):102295. doi: 10.1016/j.rpth.2023.102295. eCollection 2024 Jan.

Authors

Eva K Kempers¹, Johanna A van der Zande^{2

3}, Paula M Janssen⁴, Jérôme M J Cornette³, Jolien W Roos-Hesselink², Marieke J H A Kruip¹

Affiliations

¹ Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
² Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
³ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands.
⁴ Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Abstract

Background: The effects of antiplatelet therapy on menstrual bleeding have not been well characterized.

Objectives: To systematically review the effects of antiplatelet therapy on menstrual bleeding.

Methods: A literature search was performed for studies of reproductive-aged women who received antiplatelet therapy. Characteristics of menstrual bleeding both before and after initiation of antiplatelet therapy and from comparison groups were collected. Two reviewers independently assessed the risk of bias in individual studies.

Results: Thirteen studies with a total of 611 women who received antiplatelet therapy were included. Types of antiplatelet drugs used were aspirin (n = 8), aspirin and/or clopidogrel (n = 2), prasugrel (n = 1), and not specified (n = 2). Risk of bias was assessed at moderate (n = 1), serious (n = 8), critical (n = 2), and no information (n = 2). Three studies reported changes in menstrual blood loss volume. One of these showed no increase during antiplatelet therapy; the other 2 studies suggested that aspirin may increase menstrual blood loss volume. In 3 studies that assessed the duration of menstrual bleeding, up to 13% of women reported an increased duration of menstruation. In 5 studies that reported the intensity of menstrual flow, 13% to 38% of women experienced an increase in the intensity of flow. Five studies reported the prevalence of heavy menstrual bleeding in women who received antiplatelet therapy, with estimates ranging from 7% to 38%.

Conclusion: There is lack of high-quality data on the effects of antiplatelet therapy on menstrual bleeding. Aspirin may increase menstrual blood loss, at least in a minority of women, whereas the effects of P2Y12 inhibitors are unknown.

Keywords: aspirin; clopidogrel; menorrhagia; platelet aggregation inhibitors; systematic review.