Menstruation, anticoagulation, and contraception: VTE and uterine bleeding
Bethany Samuelson Bannow1, Claire McLintock2, Paula James3
1Division of Hematology Oregon Health & Science University Portland Oregon USA.
Research and Practice in Thrombosis and Haemostasis
|August 9, 2021
Summary
Heavy menstrual bleeding (HMB) affects many women, especially those on direct oral anticoagulants (DOACs). Early counseling and management strategies are crucial for preventing and treating HMB in these patients.
Area of Science:
- Gynecology
- Hematology
- Pharmacology
Background:
- Abnormal or excessive menstrual bleeding impacts one-third of reproductive-aged women.
- This prevalence rises to 70% in women using direct oral anticoagulants (DOACs).
Purpose of the Study:
- To review management strategies for heavy menstrual bleeding (HMB) in women using direct oral anticoagulants (DOACs).
- To emphasize proactive counseling and treatment approaches for HMB in this patient population.
Main Methods:
- Review of current medical literature on HMB management in women on anticoagulation.
- Analysis of pharmacological and procedural treatment options for HMB.
- Discussion of monitoring for complications like iron deficiency.
Main Results:
- Progestin-only therapies (e.g., levonorgestrel IUS, etonogestrel implant, progestin-only pill) are primary management options.
- Combined hormonal contraceptives and depot medroxyprogesterone acetate may be used cautiously during therapeutic anticoagulation.
- Procedural therapies are options for women who have completed childbearing.
Conclusions:
- Counseling on HMB risk should occur at DOAC initiation for all menstruating individuals.
- Management strategies should be discussed proactively, especially for those with prior HMB history.
- Monitoring and treatment of iron deficiency are essential due to HMB complications.
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