Menstrual disorders constitute a major clinical problem that affects a large number of women during their reproductive life. Although menorrhagia (heavy bleeding during menstruation) may have several causes such as local pathology, systemic disorders such as inherited clotting deficiency, thrombo-cytopenia (less number of platelets), chronic liver failure or endocrine dysfunction, anticoagulant therapy with warfarin. The specific cause is identified in only 50 percent of affected women, while the rest are labeled under a broad rubric of dysfunctional uterine bleeding (DUB).

In a study conducted at Bombay in India where 120 consecutive women presenting with menorrhagia were screened for an underlying coagulation (clotting) disorder. The study groups were women between 18 to 35 years. The study reported an incidence of 10.8 percent of von Willebrand's disease (hereditary blood disease where the mucous membrane starts to bleed without any apparent reason), 4.16 percent of platelet function defects and other rarer factor deficiency making the total to 17.5 percent of inherited bleeding disorders responsible for menorrhagia in these women. There is paucity of data from Bangladesh as regards this.

I would like to suggest an important thing that before labeling a patient with menorrhagia as dysfunctional uterine bleeding (DUB), a coagulation work up is mandatory and could be life saving in certain circumstances.

Deviation from normal menstruation is a related problem. So, it is woman's perception of a problem that initiates investigations. Unfortunately, speaking openly about menstruation makes many parents and children uncomfortable, but this is a crucial conversation that will help you and your daughter feel independent and confident. It may help to let your daughter know what is considered normal menstrual bleeding, for example, how many days a period lasts; how much blood flow to expect and so on.

Usually 80 ml of blood flow in 4 to 5 days period is considered as normal. Considering my personal experience I would like to stress the issues of perception and tolerance of symptoms. These are important in a consultation between patient and gynaecologists which warrants evaluation. The history should be taken meticulously in cases of menorrhagia.

von Willebrand's disease
von Willebrand's disease is a hereditary blood disease (occurring in both sexes) where the mucous membrane starts to bleed without any apparent reason (involving a deficiency of a clotting factor in the blood, called 'von Willebrand's factor').

VWF serves as a carrier for clotting factor VIII, a fact that helps explain why some severely affected patients with VWD develop symptoms similar to hemophilia. Symptoms of VWD include: easy bruising, frequent or prolong nosebleed, heavy or prolong menstrual bleeding, prolong bleeding following surgery, dental extraction, childbirth, injury.

A battery of tests has been devised that can diagnose the disorder with increasing accuracy. Seemingly, subtle distinctions that can have a profound impact on treatment strategies. There are pharmaceutical and plasma derived products that have been developed to treat bleeding symptoms and to prevent abnormal bleeding, such as during surgery.

Message for you
Do you have heavy or prolong menstrual periods? Do they last 10 days or more? It does not have to be that way or if you may feel symptoms of VWD immediately consult with a gyaenocologist.

The writer is a Senior Consultant Haematologist and In-charge, Lab Service, Apollo Hospitals Dhaka. E-mail: [email protected]