Menstrual bleeding-specific quality of life in women on antiplatelet therapy

Abstract

Background: Antiplatelet therapy may affect menstrual blood loss in women of reproductive age.

Objectives: To determine menstrual bleeding and related quality of life (QoL) in women on antiplatelet therapy.

Methods: We performed a cross-sectional study at a tertiary care center in the Netherlands, including women on antiplatelet therapy with an active menstrual cycle and a control group of reproductive-aged women who did not use antiplatelets. Participants completed an online questionnaire containing 2 validated instruments: (1) the Menstrual Bleeding Questionnaire (MBQ) to measure menstrual bleeding-specific QoL, and (2) the Pictorial Blood Loss Assessment Chart (PBAC). Scaled MBQ scores range from 0 to 100, with higher scores indicating worse QoL. A PBAC score of 100 is generally considered indicative of heavy menstrual bleeding.

Results: In total, 38 women prescribed antiplatelet drugs (median age, 44 years [IQR, 40-48]) and 100 control women (median age, 35 years [IQR, 27-43]) completed the study questionnaire. Most common indication for antiplatelet therapy was stroke/transient ischemic attack (26%). Acetylsalicylic acid/carbasalate calcium (50%) and clopidogrel (37%) were most frequently used. Mean (SD) scaled MBQ scores were 18.9 (11.2) among antiplatelet drug users and 22.4 (10.9) in control women (adjusted mean difference, -3.28 [95% CI, -7.90, 1.35]). Median PBAC scores were 101.5 (IQR, 50.5-207) and 96.0 (IQR, 73.0-174.8; adjusted mean ratio, 0.784 [95% CI, 0.521, 1.18]), respectively. A PBAC score >100 was reported in 37% and 36% of the antiplatelet and control groups, respectively.

Conclusion: Menstrual bleeding-specific QoL was comparable between women on antiplatelet therapy and controls, although controls experienced a high burden of menstrual bleeding-related complaints. Menstrual blood loss did not seem to be increased.

Keywords: aspirin; clopidogrel; cross-sectional studies; menorrhagia; platelet aggregation inhibitors; quality of life.

Figure 1

Menstrual Bleeding Questionnaire (MBQ) and Pictorial Blood Loss Assessment Chart (PBAC) scores in women on antiplatelet therapy and controls. (A) The total (unscaled) MBQ score ranges from 0 to 75, with higher scores indicating worse quality of life. Scores are multiplied by 1.32 to scale them from 0 to 100. (B) The PBAC score is computed by summing and multiplying the number of sanitary pads and/or tampons by a staining factor during one menstrual cycle. IQRs are indicated by the boxes, with the inner line displaying the median; whiskers extend up to 1.5∗ IQR. Individual data points are plotted.