Managing Abnormal Uterine Bleeding During Anticoagulant Therapy in Clinical Practice

Anticoagulant therapies, including heparins, vitamin K antagonists, and direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban and dabigatran, are crucial for the treatment and the prevention of venous thromboembolism (VTE). While DOACs offer improved safety profiles, their use, espe-cially in women of reproductive age, increases the risk of abnormal uterine bleeding (AUB), partic-ularly heavy menstrual bleeding (HMB). HMB, defined as blood loss exceeding 80 mL per cycle or causing significant life disruption, is associated with reduced quality of life and substantial economic costs. Women on anticoagulants report higher incidences of HMB, often requiring adjustments in therapy or additional interventions. Management strategies include the referral for a gynecological consultation, the adjustment of hormonal therapy and anticoagulant treatment, the administration of tranexamic acid, and the treatment of iron deficiency. The review underscores the importance of a comprehensive, personalized approach to managing AUB in women on anticoagulants to optimize both anticoagulation effectiveness and patient quality of life.