Elsevier

Fertility and Sterility

Volume 84, Issue 5, November 2005, Pages 1345-1351
Fertility and Sterility

Special contribution
Introduction: abnormal uterine bleeding
Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding

https://doi.org/10.1016/j.fertnstert.2005.05.035Get rights and content

The evaluation of excessive menstrual bleeding carries a relatively high yield of discovering an underlying disorder of hemostasis in females. This review highlights important components in a structured history and outlines primary and secondary hematologic testing that should be considered in the evaluation of excessive menstrual bleeding.

Section snippets

Primary evaluation for an underlying disorder of hemostasis in women with EMB

Laboratory investigation for an underlying disorder of hemostasis in a woman with EMB cannot be carried out by the practitioner who is oblivious to the clinical history. Consequently, the first step is not venipuncture but a focused history for a family history of bleeding and a personal history of bleeding symptoms (Table 2). These symptoms for all women include easy bruising of >5 cm 1–2 times/month, frequent gum bleeding when flossing or brushing teeth, and epistaxis 1–2 times per month. In

Secondary evaluation for an underlying disorder of hemostasis in women with EMB

Those women with a “positive” screen and normal platelet count should then undergo a logical, stepwise sequence of testing for various disorders of hemostasis. Accurate hemostasis testing is crucial because the specificity of bleeding symptoms is poor and many “normal” patients without an identifiable disorder of hemostasis will report bleeding symptoms (1). Hemostasis testing ideally should be done on site with immediate on-site processing, given the frequent misdiagnosis of von Willebrand

Future research in the investigation of underlying disorders in women with EMB

Finally, future clinical trials of hemostasis testing in the women with excessive menstrual bleeding should include the following:

  • 1

    In the light of the preliminary data cited above showing a relatively high prevalence of platelet function abnormalities in menorrhagia, further study of the potential role of subtle platelet aggregation and release abnormalities with concurrent study of platelet aggregation and release in normally menstruating women in determining if these abnormalities are a cause

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      They are recommended in case of evocative history of bleeding disorder. Frequent bruising, epistaxis or frequent gingival bleeding, menorrhagia since menarche, previous postpartum hemorrhage, bleeding during tooth extraction, family history of coagulation disorders [4–6,13,14,33] are many suggesting signs. The treatment of genital bleeding is based on two axes: symptomatic and etiological treatment.

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