Ten percent of women visit their GP or gynaecologist complaining of heavy periods. Marieke Knol from the University Medical Center Groningen found that 29% of these women had an underlying bleeding disorder. ‘Doctors rarely consider the possibility of a bleeding disorder as a cause of menstruation problems. The symptoms can often be treated, as well as the anaemia that many of these women develop. In addition, preventive measures need to be taken if a patient with a bleeding disorder underwent an operation,’ says Knol. She is arguing the case for specific testing for bleeding disorders in women who visit a doctor because of heavy periods. Knol will be awarded a PhD at the University of Groningen on 3 October 2012 for her research findings.
Women with a bleeding disorder often have heavy bleeding during their first period. Heavy periods is objectively defined as greater than 80 ml blood loss per menstrual cycle and the bleeding lasts longer than 7 days. According to Knol, most of these women are only diagnosed with a bleeding disorder at the relatively late age of around 40.
Knol studied the data relating to all the women referred to the Gynaecology Department of UMCG with heavy period problems in 2006. Only 2 of the 102 patients were tested for a bleeding disorder as a possible cause. Thereafter, Knol screened a total of 102 women with heavy periods between 2007 and 2010 for clotting disorders. Twenty-nine percent of these women tested positive, whereby the majority were suffering from a mild form of Von Willebrand disease. Knol concludes that underlying clotting disorders are often present in women who suffer from heavy periods and wants this to be considered as a possible cause.
The most common hereditary bleeding disorder is Von Willebrand disease (VWD). It presents as frequently in men as in women. Women with VWD have specific problems such as heavy periods and excessive bleeding after giving birth. In collaboration with the study group ‘Willebrand in the Netherlands’ Knol described that more than 80% of 432 women with VWD experienced heavy periods. Nearly all of these women used hormonal contraceptives (such as ‘the pill’) to reduce their monthly bleeding. In addition, 60% of the women were being treated for anaemia. This has a negative influence on the quality of life. More than a quarter of the women with VWD over 40 years of age underwent a hysterectomy. A hysterectomy was more often complicated by bleeding if VWD was not yet diagnosed before the hysterectomy.
Knol considers it important to detect bleeding disorders in women so that better treatment can be offered. Having VWD (or another bleeding disorder) is a reason for recommending a hospital birth, for instance. Compared with the rest of the population, women with VWD have a higher risk of bleeding after birth, and some new mothers will need a blood transfusion on account of blood loss during delivery. There are drugs that have a positive effect on clotting and can reduce the amount of blood lost during menstruation or while giving birth. Knol noted a high degree of patient satisfaction among the women receiving treatment for heavy periods.
Marieke Knol (Avereest, 1980) studied Medical Sciences in Groningen. She conducted her research in the Haemostasis and Thrombosis section of the Haematology Department and the Obstetrics and Gynaecology Department of the University Medical Center Groningen (UMCG). Knol is training to be a gynaecologist in the UMCG. Her thesis is entitled: ‘Determinants of bleeding in obstetrics and gynaecology’.
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