Could your heavy flow be cause for concern?
Sherri Ozawa, MSN, RN, tells The Post that serious blood loss during menstruation could be a symptom of von Willebrand disease, a blood disorder that compromises the body’s ability to form blood clots.
What is von Willebrand disease?
“VWD happens when the body doesn’t have enough von Willebrand factor, a protein that helps platelets stick together to form clots,” said Ozawa.
“People with VWD may bleed longer than usual after injuries, surgeries or even minor cuts. Some may have frequent nosebleeds, easy bruising or heavy menstrual bleeding.”
VWD is hereditary, and symptoms range from mild (Type 1) to severe (Type 3) with corresponding treatments.
“For mild cases (Type 1), a naturally occurring hormone called desmopressin (DDAVP) is often intravenously used to temporarily boost von Willebrand factor levels – for example, before surgeries or during bleeding episodes.
In moderate to severe cases, doctors can give patients concentrated replacement therapy derived from the plasma of blood donors or made with genetic engineering.”
How can women distinguish between a heavy period and a blood disorder?
Ozawa notes that while bleeding through pads or tampons every hour, having periods that last longer than seven days, and passing clots larger than a quarter are all cause for concern, patients cannot independently determine if they have VWD.
However, they can and should talk to their providers about the conditions of their menstrual cycles.
“Only four out of ten women who experience heavy menstrual bleeding will seek care for it,” she said.
“Research shows that less than 10% of pediatricians and family medicine doctors document a menstrual history for female patients.
“Additionally, most girls learn about menstruation from their moms, so in families that have several members with VWD, abnormal bleeding may seem normal.”
According to Ozawa, treatments for VWD and heavy menstrual bleeding include hormonal therapy such as birth control pills. She advises patients with these symptoms to avoid aspirin and other blood thinners, which can amplify blood loss.
She maintains that ignoring the symptoms of heavy bleeding can lead to serious health issues.
“If women don’t get diagnosed and treated for this heavy bleeding, it puts them at great risk for iron deficiency and anemia,” she explained. “Both problems have tremendous consequences for women and their yet-to-be-born children.”
A recent study revealed that 29% of US adults are affected by absolute or functional iron deficiencies — and nearly one in three Americans may have an undiagnosed iron deficiency.
Issues associated with iron deficiency include “poorer quality of life and academic performance, altered social relationships, increased depression risk and behavioral issues, and poorer surgical outcomes. This is in addition to the daily ‘normalized’ symptoms of feeling cold, tired/exhausted, and unable to adequately complete daily tasks at work, school, or at home,” according to Ozawa.
Why are women more at risk?
While VWD presents equally between the sexes, Ozawa says bleeding disorders have historically been underrecognized and underdiagnosed in women.
“On average, women with VWD experience a 16-year delay between the onset of symptoms and proper diagnosis,” she said.
Seventy-six percent of males are diagnosed by 10 years of age, but 50% of females are not diagnosed by 12 years of age.
“This is a problem because, without the diagnosis, we can miss the chance to advise girls on abnormally heavy menstrual bleeding,” she added.
One of the reasons for this delayed diagnosis is the stigma around menstruation. “Both patients and physicians have discomfort in discussing menstruation – what is normal, what is not and when to seek help.”
However, transparency is critical to treatment, “When doctors better understand exactly why patients are bleeding and how their blood is clotting, they can efficiently use the right treatment and not waste time, money, and resources – and they can save lives.”
Is there a cure for VWD?
While there is no known cure for VWD, it can be managed. Ozawa urges patients who suspect they might have a bleeding disorder to seek out diagnostic testing.
“With proper management, most people with VWD can lead normal lives while minimizing the risk of excessive bleeding during injuries, surgeries or everyday activities.”
