Heavy menstrual bleeding in women with a bleeding disorder of unknown cause: a common symptom impacting daily life...

Persons with an increased bleeding tendency without abnormalities in standard hemostasis tests are classified as having a bleeding disorder of unknown cause (BDUC). The majority are female, and the most common bleeding symptoms are mucocutaneous, including heavy menstrual bleeding (HMB). However, knowledge on HMB in BDUC and the impact on daily functioning is limited.

Investigate the prevalence of HMB and HMB-related quality of life (QoL) in women with BDUC, compared with women with mild bleeding disorders (MBDs) and no bleeding disorder (NBD).

Data from women included in the Maastricht Predictors of Bleeding Evaluation in Adult Hematologic Patients with Bleeding Tendencies study were used. HMB was defined as a score ≥1 on the menorrhagia subdomain of the International Society on Thrombosis and Hemostasis Bleeding Assessment Tool. HMB-related QoL was evaluated using the Menorrhagia Multi-Attribute Scale (MMAS).

In total, 317 women were included (BDUC n = 157, MBD n = 104, NBD n = 56), and 144 women completed the MMAS. HMB was significantly more prevalent in BDUC and MBD (82.8% and 71.2%) compared with NBD (39.3%); P < .001. Median total MMAS scores were lower in BDUC and MBD compared with NBD (median [IQR]: 49.8 [34.8-82.6], 54.9 [37.0-75.3], and 74.3 [IQR 46.1-100.0], P = .249). Across all groups, women with HMB had significantly lower median total MMAS scores compared with women without HMB (P = .002, P = .001, and P = .002). A higher International Society on Thrombosis and Hemostasis Bleeding Assessment Tool menorrhagia score was associated with a lower MMAS total score.

HMB is highly prevalent among women with BDUC, and HMB substantially impairs HMB-related QoL. This underscores the need for increased clinical awareness of the impact of HMB in this population and for targeted clinical guidelines and optimized management strategies.