Prevalence and Treatment of Von Willebrand Disease‐Related Menorrhagia in Adolescents: A Review

Review Article

Prevalence and Treatment of Von Willebrand Disease‐Related Menorrhagia in Adolescents: A Review

Sameh Mikhail ¹ and Peter Kouides ²
Affiliations: ¹Lombardi Cancer Center, Georgetown University Hospital, Washington, DC, USA and ²Mary M Gooley Hemophilia Center of Rochester, Rochester General Hospital, Rochester, NY, USA


ABSTRACT

Heavy menstrual bleeding is a fairly common problem among women of reproductive age and a frequent complaint among adolescents. The pathophysiological mechanisms that cause menorrhagia in adolescents are different than those that cause menorrhagia in older women. Compared with the adult menorrhagia population, there have been far fewer studies about the prevalence of bleeding disorders and the efficacy of different treatment strategies in adolescents with menorrhagia. Excessive menstrual bleeding caused by bleeding disorders results in hospitalizations, administration of blood products, time lost from school and other activities, and decreased quality of life. Moreover, managing menorrhagia in patients with undiagnosed disorders of hemostasis may be associated with unwanted risks and complications. The studies evaluating the prevalence of Von Willebrand disease (VWD) in adolescents with menorrhagia identified over 500 patients with a prevalence range from 3% to 36%, depending on the clinical setting studied. The highest prevalence is seen in adolescents referred to an outpatient hemophilia center, whereas the lowest is seen in the acute hospital setting. Treatment of VWD is often complex, requiring a combination of therapies. Furthermore, different subtypes of VWD respond differently to treatment. There are three main hemostatic agents used to stop and/or prevent bleeding at the time of hemostatic challenges, including: (1) the non‐transfusional agent desmopressin; (2) antifibrinolytic therapy; and (3) purified blood products that contain factor VIII and Von Willebrand factor concentrated from plasma. Additional treatment modalities include estrogen–progesterone preparations that are frequently adjunctive and can be an alternative to the main lines of treatment.

Keywords: Adolescents, menorrhagia, von Willebrand disease
Correspondence: Peter Kouides, Mary M Gooley Hemophilia Center, Rochester General Hospital, 1415 Portland Avenue, Suite 425, Rochester, NY 14621, USA. Tel: (1)‐585‐922‐4020; Fax: (1)‐585‐563‐1832; e‐mail: peter.kouides@rochestergeneral.org