Heavy menstruation, frequent bruising and spontaneous nosebleeds could be signs of living with a bleeding disorder. If you notice these symptoms in yourself or your child, it is important to contact your doctor.
Symptoms of bleeding disorders
- Periods lasting longer than 7 days
- Needing to change pads/tampons more frequently than every 2 hours
- Clots measuring larger than €1 coins
- Excessive bleeding after dental procedures
- Low iron levels or anaemia
- Large bruises or smaller red dots on the skin
- Very heavy bleeding after surgery or after childbirth
- Spontaneous nosebleeds that last up to 10 minutes
how to determine if your period is heavy
Bleeding more than 80ml during a period is considered heavy, though this may be difficult to measure. A good rule of thumb is that if it is necessary to change your pads or tampons every two hours or more often, you have a heavy period.
Menstrual cups are becoming more common. While some people use them for environmental reasons, they can also be helpful for people with bleeding disorders too. A menstrual cup can usually contain somewhere between 20-30 ml – a lot more than pads or tampons. Using menstrual cups may make it easier to assess how much you are bleeding.
If you think your period is heavy, write down how frequently you need to change your pads, tampons or menstrual cup and bring this information to the next visit with your doctor.
Also remember that bleeding disorders can be hereditary. Comparing oneself with other family members can therefore be misleading as they may also have an undiagnosed bleeding disorder.
Pregnancy and Bleeding disorders
During pregnancy, it is vital that there is good communication between the obstetrician, the haemophilia specialist and the paediatrician so that the pregnancy can be managed safely for mother and baby.
In preparation for delivery, a written plan should be agreed for both the mother and baby. This should include precautions during delivery, blood samples for diagnosis and the availability of appropriate factor concentrate in the event of bleeding, with instructions on dosage. The plan should be held by the mother, the paediatrician, the obstetrician and the haematologist and should be brought to the hospital when the woman is going in to have her baby.
Heavy Bleeding After Childbirth or Pregnancy
Many women with a bleeding disorder have problems with heavy bleeding after childbirth (post-partum haemorrhage (PPH)). After a delivery or miscarriage, coagulation factors that may be increased during pregnancy return to pre-pregnancy levels within 2-3 weeks of delivery. When this happens, the main risk of bleeding is after miscarriage or delivery and can occur up to six weeks after the pregnancy or miscarriage.
Depending on the woman’s factor level, prophylactic replacement therapy can be recommended to cover labour, delivery, and the immediate postpartum period (at least three to four days for vaginal delivery and five to seven days for caesarean section). Oral tranexamic acid or combined oral hormone therapies can also be used for the prevention and management of PPH. Management of PPH in women with bleeding disorders requires close collaboration between haematologist, obstetricians and anaesthetists.