Bleeding symptom assessment and hemostasis evaluation of menorrhagia

Abstract

Purpose of review: Because menorrhagia is a very common clinical condition reported by 5-10% of women of reproductive age, and in turn, because up to half of women with a normal gynecological evaluation will have laboratory abnormalities of hemostasis, it is incumbent on the part of the hematologist to be able to carry out a logical clinical and laboratory assessment for an underlying bleeding disorder after gynecological causes are ruled out.

Recent findings: Historically, the bleeding assessment of patients with bleeding symptoms in general, has been inaccurate due to the poor specificity of these symptoms. Recently, these symptoms have been refined and incorporated into a scoring system. Studies on applying this scoring system and on the specific assessment of women with menorrhagia are ongoing. Hemostasis testing is justified in women with menorrhagia and a normal gynecological evaluation, as 11-16% of them will meet the laboratory diagnosis of von Willebrand disease. An additional proportion of patients may have a decrease in platelet aggregation or release or both. A smaller proportion may have a coagulation deficiency or a defect in fibrinolysis.

Summary: Given the relatively high proportion of defects noted, after an initial assessment by the bleeding score, testing up-front should include von Willebrand factor analysis, and if normal, platelet aggregation and release studies should follow.