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Women & Bleeding Disorders

Women & Bleeding Disorders
What are the symptoms?
Many girls and women today live with heavy menstruation, frequent bruising and spontaneous nosebleeds without knowing it could be due to a bleeding disorder and in some cases there may be additional treatments that could help.
If you can recognize several of these symptoms in yourself or your child, it may be due to bleeding disorders, and then it is important that you contact your doctor. Together you can talk about your symptoms, and the doctor will assess what should happen next.

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Periods lasting for more than 7 days

Does your period (the amount may vary) usually last 7 days or more? Needing to change your pads/tampons more frequently than every 2 hours

Is your period so heavy that you have to change tampons or pads every two hours or more often? Clots during menstruation larger than €1

Do you experience having lumps (clots)
of blood larger than a €1 coin?
Excessive Bleeding after Dental Procedures

Have you experienced that you have continued to bleed after a surgery at the dentist? Low iron levels or anaemia

Have you had a low blood iron level measured, or are you taking iron tablets?

    Easy or frequent bruising

Do you often experience large, bruises, or have you experienced many smaller, red dots on the skin?
Very heavy bleeding after surgery or after childbirth
Have you experienced that after an operation or birth you have bled a lot and that the bleeding would not stop? Frequent or Heavy Nose bleeds and/or gum bleeding

Do you often get spontaneous nosebleeds that last a long time – maybe even up to 10 minutes? Family history of a bleeding disorder

Many bleeding disorders are hereditary. Do you know of any kind of bleeding disorder in your family?

READ MORE ABOUT THE SYMPTOMS
How do I know if my periods are heavier than normal?
If a woman bleeds more than 80ml during a menstrual period, menstruation is considered heavy. But it can be difficult to estimate how much 80ml is. A good rule of thumb is that if you need to change pads or tampons every two hours or more often, you have a heavy menstrual period.

Menstrual cups are becoming more common. While often considered for environmental reasons, they can be helpful in bleeding disorders too. A menstrual cup can usually contain somewhere between 20-30 ml – a lot more than pads or a tampon. For women who use menstrual cups, it may be easier to assess how much they are bleeding.

If you think you have a heavy menstrual period, whether you use pads, tampons or a cup you should write down how frequent these are changed or filled up and bring this information with you on your next visit.A bleeding disorder can be hereditary. Comparing oneself with other family members can therefore be misleading as they may also have an undiagnosed bleeding disorder.

Pregnancy in women with bleeding disorders
When a woman with a bleeding disorder is pregnant, 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 plan should be agreed for both the mother and the 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 copied to the mother, the paediatrician, the obstetrician and the haematologist. It is important that prospective mothers bring copies of their delivery plan to the hospital when they go in to have the 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 factor level of the woman, 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) in women bleeding disorders. 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.