Heavy menstrual bleeding may signal undiagnosed VWD, per case
Finally ID'ing condition allowed safe surgery for woman, 44, with bleeding disorder
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A woman in her 40s with persistent heavy menstrual bleeding was safely treated with surgery after doctors diagnosed her with von Willebrand disease (VWD), an inherited bleeding disorder, according to a new case report.
The condition had gone undiagnosed for years despite repeated episodes of heavy bleeding that required hospitalizations and, in some cases, multiple blood transfusions, according to the researchers.
Although her symptoms eased after starting VWD treatment, her heavy menstrual bleeding continued, leading doctors to perform surgery to remove her uterus, fallopian tubes, and right ovary. The procedure was safely carried out with carefully planned treatment to reduce the risk of excessive bleeding, the team noted.
“This case underscores the importance of early recognition of bleeding disorders in women with longstanding heavy menstrual bleeding,” the researchers wrote. “Implementing appropriate diagnostic evaluation and timely initiation of VWD-specific therapy can significantly reduce [disease symptoms], improve surgical outcomes, and enhance quality of life.”
The study, “Preoperative Hemostatic Management for Refractory Abnormal Uterine Bleeding in Patients With von Willebrand Disease: A Case Report,” was published in Case Reports in Obstetrics and Gynecology.
VWD, the most common inherited bleeding disorder, occurs when the body lacks enough functional von Willebrand factor (VWF), a protein that helps blood clot properly. VWF also helps protect another clotting protein, factor VIII (FVIII), from breaking down too quickly in the bloodstream.
Woman’s menstrual periods often lasted 10 days
Common VWD symptoms include frequent nosebleeds, easy bruising, and prolonged and excessive bleeding after surgery or injury. Among women, heavy menstrual bleeding is one of the most frequent symptoms, significantly affecting quality of life and increasing the risk of anemia, or low levels of healthy red blood cells.
However, heavy menstrual bleeding related to VWD is often mistaken for other gynecological conditions, delaying correct diagnosis and the start of appropriate treatment.
“Many women undergo multiple failed treatments with hormonal therapy or even unnecessary surgical interventions before hematologic evaluation [related to blood] is considered,” the researchers wrote.
Here, a team from the Universitas Indonesia detailed the case of a 44-year-old woman in Asian nation who experienced heavy menstrual bleeding for years before receiving a VWD diagnosis and appropriate treatment.
Her symptoms had persisted for four years before she was admitted for evaluation. Her menstrual periods were consistently prolonged, often lasting up to 10 days, and required frequent sanitary pad changes each day.
Many women undergo multiple failed treatments with hormonal therapy or even unnecessary surgical interventions before hematologic evaluation [testing related to blood and possible bleeding disorders] is considered.
An ultrasound examination revealed diffuse adenomyosis, a condition in which tissue from the lining of the uterus (endometrium) grows into the uterine wall. She was given hormone therapy, but the bleeding continued despite treatment, the researchers noted.
Over time, these bleeding episodes became severe enough to require repeated hospitalizations and, in some cases, multiple blood transfusions, per the report.
Woman ultimately diagnosed with VWD type 1
While the woman had no known family history of bleeding disorders, she had experienced frequent nosebleeds and easy bruising since childhood. She also reported unusually heavy and prolonged menstrual bleeding since adolescence, sometimes lasting for months.
After delivering her first child by cesarean section, she developed extensive bruising that took a long time to heal. Further, her postpartum menstrual bleeding remained heavy for up to three months. The woman also reported occasional unexplained bruising on her arms and legs and prolonged bleeding from minor cuts.
Suspecting an underlying bleeding disorder, the doctors requested additional blood tests.
The results showed reduced levels of VWF, along with reduced VWF activity, and mildly decreased levels of FVIII. Further testing confirmed a pattern consistent with VWD type 1, the most common form of the condition.
Doctors turned to surgery to resolve woman’s heavy bleeding
Despite targeted treatment with DDAVP (desmopressin), which significantly eased her bleeding symptoms, the woman continued to experience heavy menstrual bleeding, according to the researchers.
Her doctors therefore scheduled a laparoscopic hysterectomy — a minimally invasive surgery to remove the uterus — along with removal of both fallopian tubes and the right ovary.
Because VWD increases the risk of excessive bleeding during surgery, doctors gave the woman several treatments beforehand to help her blood clot more effectively. These included DDAVP and tranexamic acid (sold under the brand names Cyklokapron and Lysteda, besides generic formulations).
After the procedure, DDAVP and tranexamic acid were continued for a week to support blood clotting. The woman remained stable without experiencing episodes of major bleeding, the researchers noted.
“This case highlights the importance of evaluating underlying bleeding disorders, such as VWD, in women with persistent heavy menstrual bleeding that does not improve with standard therapy,” the researchers concluded, adding that “early recognition supported timely and appropriate” treatment to reduce bleeding risk before surgery.
According to the researchers, “a multidisciplinary approach is essential to improve clinical outcomes and overall quality of life in patients with [hard-to-treat uterine bleeding] due to VWD.”
