Bleeding Disorders in Women

Bleeding disorders are a group of disorders associated with a lack of any number of clotting elements in the blood. These proteins work together as a domino effect to blood clotting, so any disruption along that line can lead to a bleeding disorder.

Hemophilia is the most well known bleeding disorder, recognized since biblical times, occurs almost exclusively in males, although it's inherited through the mother on the X chromosome. People with hemophilia have problems associated with internal bleeding into the joints, muscles and organs. Another form of hemophilia, known as hemophilia B is associated with a missing clotting factor known as factor IX. Although it's very rare, hemophilia can occur in women.

Von Willebrand disease, vWD, identified in 1925 by a Finnish doctor, affects both men and women in equal numbers. It's actually more common than hemophilia, but less well known. The disease involves an inability of platelets to form a stable clot, which prevents a person to stop bleeding. The most common type of vWD is Type I, a mild form of the disease. Affected people typically have symptoms of bleeding in the intestines and gums. In men with Type I vWD serious bleeding is not usually a problem except in severe trauma. In women, however, because of pregnancies or menstrual periods each month, the symptoms of even mild von Willebrand's disease can affect the quality of life, causing chronic anemia, reproductive problems and hemorrhage.

In women the main symptoms of Von Willebrand's Disease is menorrhagia, which means heavy bleeding during menstruation or after childbirth. Other causes of menorrhagia are medications, tumors, intra-uterine devices (IUD) and other diseases. Out of the 15-20 percent of U.S. women who suffer from menorrhagia, as many as 20 percent of them may have a bleeding disorder.

The definition and diagnosis of heavy menstrual bleeding in women is tricky, because how one defines "heavy bleeding" is such a relative concept. Since bleeding disorders tend to run in families, having a heavy menstrual flow may be considered normal in that family and not thought as a serious medical problem. However, if your heavy bleeding started at or near your first period, there is a high probability that it's caused by a coagulopathy (bleeding disorder).

Because heavy periods are often considered by doctors to be a problem with the uterus, rather then a bleeding problem, women are often misdiagnosed and subjected to unnecessary and dangerous surgical procedures such as dilation and curettage (D&C) and hysterectomy. In one study of females with Von Willebrand's disease, 25 percent of these women had undergone hysterectomy, often to alleviate the heavy menstrual bleeding. Correct diagnosis can help a woman avoid potentially dangerous complications and surgery. All that is needed to diagnose Von Willebrand's disease is a simple blood test.

Luckily there is a treatment for vWD. Taking birth control pills can control heavy menstrual periods. There is also a hormonal nasal spray, Desmopressin, DDAVP. This synthetic hormone raises the levels of von Willebrand's factor and factor Vlll, both of which are low in vWD. This drug is given to a woman just prior to the beginning of their menstrual period and before any surgery.