[Increased menstrual bleeding among direct oral anticoagulant users]

Area of Science:

• Pharmacology
• Gynecology
• Hematology

Background:

• Direct oral anticoagulants (DOACs) are increasingly used by women of reproductive age.
• Anticoagulant use, particularly DOACs, is associated with a significantly increased risk of severe menstrual bleeding.

Observation:

• A 49-year-old woman experienced persistent heavy menstrual bleeding despite oral contraceptives, anticoagulation with rivaroxaban, and hormonal therapy (leuproreline).
• The patient required multiple blood transfusions, necessitating a change in anticoagulant and ultimately a hysterectomy.

Findings:

• Rivaroxaban may present a higher risk of severe menstrual bleeding compared to vitamin K antagonists, while dabigatran might pose a lower risk.
• Severe menstrual bleeding risk with anticoagulants is elevated in women with pre-existing heavy menstrual periods.

Implications:

• Management strategies for anticoagulant-induced menstrual bleeding include changing anticoagulant type and employing hormonal or non-hormonal therapies.
• Further research is needed to optimize anticoagulant selection and management protocols for women of reproductive age experiencing heavy menstrual bleeding.