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How do anticoagulants impact menstrual bleeding and quality of life? - The PERIOD study
Jignesh P Patel1,2, Obianuju Nzelu3, Lara N Roberts1
1King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital Foundation NHS Trust, UK.
Insights
Anticoagulant therapy significantly increases heavy menstrual bleeding and negatively impacts quality of life in menstruating women. Healthcare providers should address this common side effect to improve patient well-being.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Hematology
Background:
- Heavy menstrual bleeding is increasingly recognized as a complication for menstruating women prescribed anticoagulant medications.
- Anticoagulants are vital for preventing thrombotic events but can exacerbate menstrual blood loss.
Purpose of the Study:
- To quantify the extent of menstrual bleeding in women initiating anticoagulant therapy.
- To assess the impact of anticoagulant-induced bleeding on women's quality of life.
Main Methods:
- A prospective study involving women aged 18-50 initiating anticoagulant therapy and a control group.
- Participants completed validated questionnaires, including the Menstrual Bleeding Questionnaire and Pictorial Blood Assessment Chart (PBAC), over two menstrual cycles.
- Statistical comparison of bleeding patterns and quality of life scores between the anticoagulated and control groups.
Main Results:
- Two-thirds of women on anticoagulants reported heavy menstrual bleeding, with increased cycle length compared to controls (P < .05).
- Anticoagulated women exhibited significantly higher PBAC scores, indicating greater blood loss (P < .05).
- Initiation of anticoagulation led to a significant decline in reported quality of life scores (P < .05).
Conclusions:
- Heavy menstrual bleeding is a prevalent issue affecting two-thirds of women starting anticoagulants, significantly impacting their quality of life.
- Clinicians must be aware of this adverse effect and implement strategies to mitigate its impact on menstruating individuals.
Background:
There is increasing recognition that menstruating women prescribed anticoagulants experience heavy menstrual bleeding.
Objectives:
The aim of this study is to report the extent of bleeding in menstruating women after commencing anticoagulants and the impact it has on their quality of life.
Methods:
Women aged 18 to 50, initiated on anticoagulant therapy, were approached to take part in the study. In parallel, a control group of women was also recruited. Women were asked to complete the menstrual bleeding questionnaire and a pictorial blood assessment chart (PBAC) during their next 2 menstrual cycles. Differences between the control and anticoagulated group were compared. Significance was considered at < .05. Ethics committee approval: REC reference: 19/SW/0211.
Results:
Fifty-seven women in the anticoagulation and 109 women in the control group returned their questionnaires. Women in the anticoagulated group reported an increase in the median length of their menstrual cycle from 5 to 6 days after commencing anticoagulation, compared to 5 days for women in the control group (P < .05). Anticoagulated women reported significantly higher PBAC scores as compared to the control group (P < .05), with two-thirds of women in the anticoagulation group reporting heavy menstrual bleeding. Women in the anticoagulation group reported worsening quality of life scores following the initiation of anticoagulation, compared with women in the control group (P < .05).
Conclusion:
Heavy menstrual bleeding occurred in two-thirds of women commencing anticoagulants, who completed a PBAC, which had negative impact on their quality of life. Clinicians commencing anticoagulation therapy should be mindful of this, and recognized measures should be taken to help minimize this problem for menstruating individuals.
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