How might things change over a lifetime?
Puberty: menstrual bleeding can be especially heavy when a girl first starts having periods. When there is a family history of VWD or it is known that she has VWD, a girl should be followed closely by her medical team during puberty and may need treatment if she has heavy bleeding.
Sexual intercourse: some women with VWD may experience bleeding if there are small tears in their vagina after sexual intercourse. This can happen during their first sexual experience when the hymen is broken. It can also occur after childbirth and menopause when the vaginal wall may be thinner and dryer due to a drop in oestrogen levels - oestrogen creams for the vaginal wall and/or lubricants can help with this.
Pregnancy and childbirth: most women with VWD do not have a problem with delivering a healthy baby. Pregnancy can cause blood levels of VWF to increase, decreasing the likelihood of bleeding complications during pregnancy and delivery. However, this needs to be monitored as women with VWD can have heavy bleeding for an extended period after delivery when their factor levels return to their usual levels.
To minimise the chances of complications:
- Discuss VWD with a genetic counsellor, your haematologist and an obstetrician before you become pregnant
- Before you have any invasive procedure, such as amniocentesis, ask your haematologist if you are at risk of bleeding and whether anything needs to be done to prevent it
- During your third trimester, you should have blood tests to measure VWF to help plan for delivery and for any treatments to prevent potential post-delivery bleeding
- Discuss your choices for anaesthesia, especially an epidural, with your haematologist, obstetrician, and if possible, your anaesthetist
- Unless prenatal testing has shown the opposite, it should be assumed that the baby may have VWD and delivery methods should be as gentle as possible. A caesarean section is not usually required.
For information on how VWD is passed on from parent to child, see the inheritance section.
Menopause: When a woman begins menopause, her body’s erratic hormone regulation can increase her risk of unpredictable and heavy menstrual bleeding. However, for some women with VWD, levels of VWF rise as they age and normalise so that bleeding problems reduce. Keeping a close relationship with her gynaecologist in the years before menopause will help a woman with VWD be prepared to manage any problems that might occur.