Hormone therapies are the most common form of treatment in women with a bleeding disorder. Combined hormonal therapies can help reduce menstrual blood loss during a period and possibly increase factor VIII and von Willebrand’s factor levels. Combined hormonal contraceptives currently available include combined oral pill, transdermal patches, and intrauterine devices (IUD). In women with bleeding disorders, they can control bleeding and midcycle pain.
While these therapies also provide birth control and reduction in other menstrual problems, it is important to talk to your clinician about issues you are having with these therapies or what your plans are for family planning as other therapies may be also suggested.
There are therapies that directly work on the clotting of the blood. These therapies include DDAVP (Desmopressin), Tranexamic acid (Cyclokapron) and coagulation factor concentrates. In addition to their use for general bleeding symptoms, they can also be used in addition to hormone therapies in controlling heavy menstrual bleeding in women with bleeding disorders. They can also be used as a treatment option for women who are trying to conceive or have difficulties with hormone therapies.
Tranexamic acid (also known as Cyklokapron)
Tranexamic acid (also known as Cyklokapron) is an anti-fibrinolytic agent. This means that it slows the breakdown of blood clots. It is used to prevent or treat bleeding from mucous membranes such as the inside of the mouth, nose, gut or womb. It may be given before dental work, for nosebleeds. It is often used in treating prolonged or heavy menstrual bleeding. It may be used alone or in combination with DDAVP and factor concentrates Note: A person with urinary tract bleeding (blood in the urine) should not take this drug.
DDAVP can be given by intravenous injection or subcutaneously. It is used for haemophilia A and certain types of vWD. It causes the body to release stored vWF and FVIII and can be used for a maximum of 3-4days. If there are limited stores of vWF and FVIII, in the body already it may not be as useful. Also if the stored vWF does not function properly, it may have limited effect if more poor functioning vWF is released. Tests can be carried out during your clinic visits to find out if you are DDAVP responsive or not. This is important information as it will help in the event of an emergency or planned surgeries.
Both tranexamic acid and DDAVP alone or in combination may be effective in controlling bleeding symptoms.
Treatment with clotting factor concentrate may also be required. This replaces the missing protein in the blood with an injection into the vein. As the clotting factor that causes the blood not to clot is different each type of bleeding disorder, so is the clotting factor replacement therapy. It is good to know which treatment is available in the country or the name of one you have used in the past as this can be useful when talking with your doctor.
Prophylaxis is often recommended to prevent bleeding. This is the regular use of clotting factor replacements. This can be regular at the same times every week. Some women choose to do prophylaxis just during their period to reduce bleeding.
This is an option that is not used very frequently but in severe cases can be used to manage bleeding symptoms where other treatment is difficult or is unsuccessful. Surgical options include hysterectomy (removing the uterus) and endometrial ablation (removes the lining of the uterus). These surgical options remove the possibility of future pregnancy.