Symptomatic carriers of hemophilia and women with von Willebrand disease or other bleeding disorders have special gynecologic and reproductive concerns. These include excessive menstrual bleeding and excessive bleeding after childbirth or miscarriage. Excessive menstral flow may be incorrectly diagnosed as a gynecological problem when in fact, a bleeding disorder may be the underlying problem. Women with a family history of heavy periods may assume that this is normal based on the experience(s) of their mothers and/or sisters.

Longer and heavier menstrual flows often lead to low iron levels. Therefore, it is recommended that women with bleeding disorders be tested routinely for anemia. To help control menstrual bleeding, doctors may prescribe birth control pills or Stimate nasal spray. These will boost factor VIII and von Willebrand factor levels. If these treatments are not effective, more extreme procedures might be considered. These might include a D&C (dilation and curettage, a scraping of the lining of the uterus) or hysterectomy (surgical removal of the uterus). Decisions about what path to pursue should be based on personal preference, family planning goals, and severity of bleeding problems, and should be discussed by women and their doctors.

During pregnancy, levels of factor VIII and von Willebrand factor usually increase in women with bleeding disorders. For women with vWD, postpartum bleeding may be treated with desmopressin acetate or a von Willebrand factor-containing concentrate. A woman who becomes pregnant should see an obstetrician as soon as possible. This will ensure that the doctor can work with the local hemophilia treatment center to provide pre and postnatal care for the woman and her fetus and arrange for testing of the baby.

Miscarriages and abortions, even early in the course of a pregnancy, can result in excessive bleeding. Women who know or think they are miscarrying should promptly seek medical care.

Reprinted, with permission, of the National Hemophilia Foundation, Inc.