[Increased menstrual bleeding among direct oral anticoagulant users]

Two-thirds of users of oral anticoagulants use direct oral anticoagulants, among which increasingly women in their reproductive age. The risk of severe or abnormal menstrual bleeding doubles to 70% when using anticoagulants. With rivaroxaban especially the risk seems higher than with vitamin K antagonists; with dabigatran possibly lower.

We saw a 49-year-old woman who started the oral contraceptive pill because of heavy menstrual bleeding. After getting deep vein thrombosis we stopped the pill and started rivaroxaban. Despite leuproreline the heavy bleeding persisted and 6 blood transfusions were necessary, after which the type of anticoagulant was changed. Eventually, we performed a hysterectomy.

Anticoagulants can cause severe menstrual bleeding, especially in women with a history of heavy menstrual periods. The type of anticoagulant can be changed and the bleeding can be treated by both hormonal and non-hormonal therapies.