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Review
. 2022 Aug;198(4):753-764.
doi: 10.1111/bjh.18291. Epub 2022 Jun 3.

Menstrual problems in chronic immune thrombocytopenia: A monthly challenge - a cohort study and review

Wobke E M van Dijk  1 , Marieke C Punt  1 , Karin P M van Galen  1 , Jeanette van Leeuwen  2 , A Titia Lely  2 , Roger E G Schutgens  1
Affiliations
Review

Menstrual problems in chronic immune thrombocytopenia: A monthly challenge - a cohort study and review

Wobke E M van Dijk et al. Br J Haematol. 2022 Aug.

Abstract

Immune thrombocytopenia (ITP) may cause menstrual problems. This cross-sectional study assessed menstrual problems in premenopausal chronic ITP women by several questionnaires, including the pictorial bleeding assessment calendar (PBAC; score ≥100 indicates heavy menstrual bleeding [HMB]), and the menorrhagia multiattribute scale (MMAS). Spearman was used for assessing correlations. A literature review was performed in Pubmed. The cohort comprised 37 women (mean age 31 ± 9). A total of 29/37 (78%) had experienced clinical menstrual problems in the present or past. Of the 33 patients who returned the PBAC, 13 (39%) had a score of ≥100. The median MMAS score was 79 (IQR 60-95). The PBAC scores correlated with the MMAS. Both questionnaires were unrelated to the platelet count. Patients with a levonorgestrel intrauterine device (LNG-IUD) had lower PBAC scores than patients with other or no hormonal therapy. MMAS scores were correlated with fatigue. The review identified 14 papers. HMB occurred in 6%-55% at ITP diagnosis and 17%-79% during disease. Menstrual symptoms influenced the quality of life, particularly in patients with a low platelet count. This explorative study suggested that HMB is frequent in women with chronic ITP despite management and platelet counts >50 *109 /l. An LNG-IUD seemed to reduce blood loss significantly.

Keywords: heavy menstrual bleeding; immune thrombocytopenia; menstrual problems; menstruation; quality of life.

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Conflict of interest statement

R.E.G. Schutgens received a grant from Novartis. The other authors have no potential conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
The (A) pictorial bleeding assessment calendar (PBAC) and (B) menorrhagia multiattribute scale (MMAS) scores per contraceptive group. The “other”‐group includes one patient with contraceptive injections and one patient with a vaginal ring (NuvaRing). LNG‐IUD, Levonorgestrel intrauterine device; OCP, Oral contraceptive pills.
FIGURE 2
FIGURE 2
The (A) pictorial bleeding assessment calendar (PBAC) and (B) menorrhagia multiattribute scale (MMAS) scores in relation to the platelet count. [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
PRISMA flowchart of study selection. [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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