ABSTRACT
von Willebrand disease (vWD) is the commonest bleeding disorder in women. More than
70% of women with vWD suffer from menorrhagia and half of them suffer from dysmenorrhea.
There is also the risk of hemorrhage with ovulation and mid-cycle pain. These have
a significant effect on all aspects of quality of life. vWD also can be the underlying
cause of menorrhagia in a small but significant proportion of women. There are still
several unanswered issues in the diagnosis and management of menorrhagia in these
women. There is no consensus whether testing for vWD should be part of the routine
investigations in menorrhagia. Diagnosis of vWD is difficult. There are intraindividual
variations in von Willebrand factor and factor VIII levels influenced by age, race,
and blood group. This is further complicated in women because of the fluctuation of
these factor levels during the menstrual cycle and possibly with hormonal therapy.
The diagnosis of menorrhagia is also difficult due to the lack of a simple objective
tool for the assessment of menstrual blood loss. In vWD, the treatment of menorrhagia
is usually medical, but there is lack of prospective data on the efficacy of commonly
used medical therapies in these women. The levonorgestrel intrauterine system, Mirena,
is effective and should be considered prior to surgical management. Surgical interventions
may be required in patients unresponsive to medical treatments. These procedures can
be complicated by hemorrhage in these women. A multidisciplinary approach in the management
of these women is essential in ensuring an optimal outcome. Multicenter clinical trials
are required to answer the controversial issues in the management of women with vWD.
KEYWORDS
von Willebrand disease - women - menorrhagia - management - diagnosis
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Dr.
R.A. Kadir
Department of Obstetrics and Gynaecology, Royal Free Hospital
Pond Street, London NW3 2QG, United Kingdom
Email: rezan.abdul-kadir@royalfree.nhs.uk
