Bleeding symptom assessment and hemostasis evaluation of menorrhagia

Because menorrhagia is a very common clinical condition reported by 5-10% of women of reproductive age, and in turn, because up to half of women with a normal gynecological evaluation will have laboratory abnormalities of hemostasis, it is incumbent on the part of the hematologist to be able to carry out a logical clinical and laboratory assessment for an underlying bleeding disorder after gynecological causes are ruled out.

Historically, the bleeding assessment of patients with bleeding symptoms in general, has been inaccurate due to the poor specificity of these symptoms. Recently, these symptoms have been refined and incorporated into a scoring system. Studies on applying this scoring system and on the specific assessment of women with menorrhagia are ongoing. Hemostasis testing is justified in women with menorrhagia and a normal gynecological evaluation, as 11-16% of them will meet the laboratory diagnosis of von Willebrand disease. An additional proportion of patients may have a decrease in platelet aggregation or release or both. A smaller proportion may have a coagulation deficiency or a defect in fibrinolysis.

Given the relatively high proportion of defects noted, after an initial assessment by the bleeding score, testing up-front should include von Willebrand factor analysis, and if normal, platelet aggregation and release studies should follow.