The Curbsiders Internal Medicine Podcast #280 Heavy Menstrual Bleeding, Anticoagulation & Coagulopathy in Menstruating Patients
Jun 21, 2021
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Bleeding Disorders Behind Heavy Periods
- About 20% of women with heavy menstrual bleeding have an underlying bleeding disorder, most commonly von Willebrand disease.
- Many bleeding disorders present as mucocutaneous bleeding rather than joint bleeds typical of hemophilia.
Tonsillectomy As A Useful Screening Question
- Dr. Bannow asks whether patients bled after procedures like a tonsillectomy because surgical bleeding is a strong screening clue.
- She rarely sees bleeding disorders in patients who had no abnormal bleeding after common procedures.
Use Tranexamic Acid Confidently
- Prescribe tranexamic acid (1,300 mg PO) for heavy bleeding; reassure patients it does not increase thrombosis risk.
- Use generic formulations to reduce cost and consider insurance limits on days supplied.