BLEEDING DISORDERS IN WOMEN

CLINICAL PRACTICE GUIDELINES
Hemophilia and von Willebrand's disease: 2. Management
(Edition 2, Update 2 [1999-07-07])

As the inheritance of von Willebrand's disease is autosomal, equal numbers of women and men are affected. However, the clinical manifestations of this typically mild bleeding disorder are often much more prominent in women, in whom menorrhagia is a frequent manifestation. Furthermore, women who are hemophilia carriers may have sufficiently low factor VIII or factor IX levels to have excessive bleeding following trauma or surgery. Rarely, carriers with extreme Lyonization may have factor levels as low as the more typical male patient with hemophilia and similarly severe clinical bleeding problems.
For women with von Willebrand's disease, gynecological bleeding can be an additional problem. Physicians should be aware that menorrhagia may be related to an underlying bleeding disorder in addition to gynecological causes. Useful agents in management include desmopressin, antifibrinolytics and oral contraceptives, alone or in combination.

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