Heavy Menstrual Bleeding? How to Spot von Willebrand Disease

Sally Owens McAlister, BSN

Disclosures|June 21, 2011

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Hello. As part of the CDC Expert Video Commentary on Medscape, I would like to speak with you today about von Willebrand disease, a bleeding disorder in which the blood does not clot properly. It is the most common bleeding disorder in the United States, affecting up to 1% of the population. However, most people who have von Willebrand disease are not aware they have it.

Blood contains proteins that help to stop bleeding. Von Willebrand disease can occur as a result of a defect or a deficiency of von Willebrand factor that prevents the platelets from becoming sticky and prevents the formation of a platelet plug to stop bleeding. Von Willebrand disease is a genetic disorder that can be passed down from either parent to the child.

Although von Willebrand disease occurs equally among men and women, women are more likely to notice the symptoms because of heavy or abnormal bleeding during their menstrual periods and after childbirth. Heavy menstrual periods are a common complaint among women. About 15% of all referrals to gynecologists and 100,000 hysterectomies per year are for heavy menstrual bleeding. Up to 20% of women with heavy menstrual bleeding are estimated to have von Willebrand disease and could be treated to lessen their symptoms.

The most common symptom is heavy menstrual periods, which are defined as

Bleeding for more than 7 days from the time bleeding begins before it completely stops;
Flowing or gushing of blood such that it limits daily activities such as housework, exercise, or social activities;
Passing clots that are bigger than a quarter, or
Changing a tampon or pad, possibly even both, every hour or more often on heaviest day(s).

Other symptoms and signs include a past diagnosis of anemia or decreased iron levels; or heavy bleeding as a result of:

Dental or other surgery, or childbirth;
Frequent nose bleeds (lasting longer than 10 minutes);
Bleeding from cuts or injuries (lasting longer than 5 minutes); or
Easy bruising (occurring weekly and presenting as raised bruises or bruises larger than a quarter in size or both).

A family history of a bleeding disorder is also an indication of von Willebrand disease. Even 1 of these signs or symptoms can suggest von Willebrand Disease. A daily journal to note the amount of menstrual bleeding over several cycles can help determine if bleeding is abnormal.

In addition to heavy menstrual bleeding, these women might experience miscarriage or postpartum bleeding, or undergo unnecessary surgical procedures such as a hysterectomy. They are prone to miss work or school and experience activity limitations, all of which can decrease their quality of life.