With diagnosis and appropriate treatment, these bleeding problems can be dramatically reduced and sometimes even eliminated. Women who have menorrhagia or abnormal vaginal bleeding need a full gynaecologic consultation before treatment to understand any gynaecological issues.
Bleeding disorder treatments for heavy menstrual bleeding include:
- Tranexamic acid and aminocaproic acid, antifibrinolytic drugs which can reduce bleeding by slowing the breakdown of blood clots
- Oral contraceptives (“the Pill”) combining the hormones oestrogen and progesterone. The hormones increase VWF and factor VIII in the blood and reduce menstrual blood loss. Although it also has the effect of preventing pregnancy, in this case the treatment’s aim is to manage VWD symptoms and so it may also be suitable for teenage girls who are not sexually active and women who are not specifically seeking birth control
- An intrauterine device (IUD), releasing the hormone progesteronewhich reduces bleeding
- Desmopressin (DDAVP), a synthetic hormone which stimulates the body to release VWF and factor VIII
- Clotting factor concentrate made with von Willebrand factor (VWF) and factor VIII (FVIII), which replaces the missing VWF and FVIII in the blood and helps blood to clot. This clotting factor concentrate is made from the plasma (pale yellow fluid part) in human blood and is produced from blood donations. This clotting factor concentrate is used in uncommon circumstances, such as when other treatments have not been effective, and when the woman is trying to become pregnant, or when it is likely the person will need treatment for more than 2-3 days, and in discussion with the specialist haematologist at the Haemophilia Centre. The treatment is infused (injected) into a vein in the arm
- Iron supplements for anaemia.
Women with bleeding disorders should avoid taking non-steroidal anti-inflammatory drugs for period pain, unless prescribed by a doctor with expertise in VWD (ie, Naprosyn/naproxen, ibuprofen, etc – these have many brand names; ask your local pharmacist to check for you). These medicines can interfere with the way platelets promote clotting and cause bleeding to go on for longer.
Generally, treatment options with medication will be exhausted before considering surgery such as hysterectomy (surgical removal of the uterus) or procedures such as endometrial ablation, where the lining of the uterus is destroyed to reduce menstrual blood loss. Surgery and some procedures have their own risk of bleeding complications for women with VWD.
However, some women with VWD may need to have gynaecological surgery or procedures for other reasons. If this happens, it is important that this is managed in a team, with discussion between the woman, the Haemophilia Centre and the gynaecologist and/or surgeon.