World Haemophilia Day: Addressing the stigma of bleeding disorders in women

Bleeding disorders in women are often disregarded and frequently misunderstood.Cultural stigma around menstruation and persistent gender bias further contribute to delays in diagnosis and care.

Inherited conditions such as von Willebrand disease (vWD), platelet function disorders, and other rare clotting factor deficiencies should be considered in women with abnormal uterine bleeding (AUB). Among these, vWD is the most prevalent, affecting approximately 0.6–1% of the population.When women present with abnormal uterine bleeding (AUB), especially when it's persistent or unexplained, healthcare providers should consider a bleeding disorder as part of the differential diagnosis. This is especially important in cases of postpartum haemorrhage or if there’s prolonged bleeding after minor procedures.

Heavy menstrual bleeding—defined as losing more than 80 mL of blood per cycle or bleeding for more than seven days—may be the only visible sign of a mild bleeding disorder. Other warning signs include easy bruising, frequent nosebleeds or gum bleeding, extended bleeding after dental procedures, and a family history of bleeding issues. Delayed postpartum haemorrhage (especially secondary PPH) should also raise red flags for a potential undiagnosed clotting disorder. A thorough bleeding history is essential for evaluation.

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The initial workup should include basic labs and a pelvic ultrasound. Recommended tests include:

• Complete blood count (CBC) with platelets

• Prothrombin time (PT) and activated partial thromboplastin time (aPTT).

• Fibrinogen levels

• Iron studies

If there's still a strong clinical suspicion, additional investigations should be considered:

• von Willebrand factor antigen and activity (ristocetin cofactor assay)

• Factor VIII levels

• Platelet function tests

Treatment is determined by the particular diagnosis and the severity of symptoms.For those with vWD, desmopressin (DDAVP) is effective in many cases. Antifibrinolytics like tranexamic acid help manage heavy periods and bleeding during surgeries. Hormonal therapies—including combined birth control pills or the levonorgestrel-releasing intrauterine system (LNG-IUS)—can significantly reduce menstrual blood loss. In more complex or severe cases, referral to a haematologist and clotting factor replacement may be necessary.

- Dr KinjalAvdhutKothari, Associate Consultant Obstetrics and Gynaecology, Manipal Hospital, Goa