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Andra H James - One of the best experts on this subject based on the ideXlab platform.
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von willebrand factor for Menorrhagia a survey and literature review
Haemophilia, 2016Co-Authors: Margaret V Ragni, Andra H James, Claire S Philipp, Nicoletta Machin, Lynn M Malec, Craig M Kessler, B A Konkle, Peter A Kouides, Anne T Neff, Donald BrambillaAbstract:Background von Willebrand disease (VWD) is the most common congenital bleeding disorder. In women, Menorrhagia is the most common bleeding symptom, and is disabling with iron deficiency anaemia, high health cost and poor quality of life. Current hormonal and non-hormonal therapies are limited by ineffectiveness and intolerance. Few data exist regarding von Willebrand factor (VWF), typically prescribed when other treatments fail. The lack of effective therapy for Menorrhagia remains the greatest unmet healthcare need in women with VWD. Better therapies are needed to treat women with Menorrhagia. Methods We conducted a survey of US haemophilia treatment centres (HTCs) and a literature review using medical subject heading (MeSH) search terms ‘von Willebrand factor,’ ‘Menorrhagia’ and ‘von Willebrand disease’ to assess the use of VWF in Menorrhagia. Analysis was by descriptive statistics. Results Of 83 surveys distributed to HTC MDs, 20 (24.1%) provided sufficient data for analysis. Of 1321 women with VWD seen during 2011–2014, 816 (61.8%) had Menorrhagia, for which combined oral contraceptives, tranexamic acid and desmopressin were the most common first-line therapies for Menorrhagia, whereas VWF was third-line therapy reported in 13 women (1.6%). Together with data from 88 women from six published studies, VWF safely reduced Menorrhagia in 101 women at a dose of 33–100 IU kg−1 on day 1–6 of menstrual cycle. Conclusions This represents the largest VWD Menorrhagia treatment experience to date. VWF safely and effectively reduces Menorrhagia in women with VWD. A prospective clinical trial is planned to confirm these findings.
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evaluation and management of acute Menorrhagia in women with and without underlying bleeding disorders consensus from an international expert panel
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011Co-Authors: Andra H James, Jennifer E. Dietrich, Peter A Kouides, Rezan Abdulkadir, Mans Edlund, Augusto B Federici, Susan Halimeh, Pieter Willem Kamphuisen, Oscar Martinezperez, Claire MclintockAbstract:Abstract Acute Menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology reached consensus on recommendations regarding the management of acute Menorrhagia in women without a diagnosed bleeding disorder, as well as in patients with von Willebrand disease, platelet function disorders and other rare hemostatic disorders. The causes and predictors of acute Menorrhagia are discussed and special consideration is given for the treatment of women on anticoagulation therapy. This review and accompanying recommendations will provide guidance for healthcare practitioners in the emergency management of acute Menorrhagia.
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Adolescent Menorrhagia due to platelet function disorder.
Journal of Pakistan Medical Association, 2010Co-Authors: Nazli Hossain, Tasneem Farzana, Nusrat H Khan, Tahir Sultan Shamsi, Andra H JamesAbstract:: The prevalence of Menorrhagia in adolescent populations with bleeding disorders varies between 14% to 48%. The common conditions associated with Menorrhagia include von Willebrand disease (VWD), platelet function disorders and coagulation factor deficiencies. The majority of studies, which have been conducted in the West, report VWD, as the most common inherited bleeding disorder leading to Menorrhagia, whereas studies from South-East Asia have found platelet function disorder as the leading inherited bleeding disorder in women with Menorrhagia. The other common conditions which can lead to increased blood loss in this age group are anovulatory bleeding and hormonal disorders. We report here three cases of adolescent Menorrhagia due to platelet function disorders, along with review of literature.
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von willebrand disease and other bleeding disorders in women consensus on diagnosis and management from an international expert panel
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Andra H James, Peter A Kouides, Rezan Abdulkadir, Mans Edlund, Augusto B Federici, Susan Halimeh, Pieter Willem Kamphuisen, Oscar Martinezperez, Barbara A Konkle, Claire MclintockAbstract:Reproductive tract bleeding in women is a naturally occurring event during menstruation and childbirth. In women with Menorrhagia, however, congenital bleeding disorders historically have been underdiagnosed. This consensus is intended to allow physicians to better recognize bleeding disorders as a cause of Menorrhagia and consequently offer effective disease-specific therapies.
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Testing for von Willebrand disease in women with Menorrhagia: a systematic review.
Obstetrics & Gynecology, 2004Co-Authors: Andra H James, David B Matchar, Evan R MyersAbstract:OBJECTIVE: To review the evidence supporting screening of adult women with Menorrhagia for von Willebrand disease. DATA SOURCES: MEDLINE search from January 1,1990, to December 31, 2003, for articles in English, using keywords “Menorrhagia,” “von Willebrand disease,” “diagnosis,” and “screening,” with a hand-search of bibliographies of identified articles, review of published abstracts, and discussion with experts. METHODS OF STUDY SELECTION: One hundred seven articles meeting search criteria were reviewed. Articles included in the study were those that provided primary data on the prevalence of von Willebrand disease in adult women with Menorrhagia, quality of life, surgical complications, and the effectiveness of medical therapy in women with Menorrhagia and von Willebrand disease and test characteristics of screening tests for von Willebrand disease. TABULATION, INTEGRATION, AND RESULTS: The reported prevalence of von Willebrand disease in women with Menorrhagia ranged from 5–20% in 5 published studies. Comparison of results was limited by small sample sizes and large confidence intervals, as well as differences in the definitions of Menorrhagia and von Willebrand disease used in the studies. Although Menorrhagia in women with known von Willebrand disease has a substantial impact on quality of life, there are no data suggesting that this impact is substantially greater than that of Menorrhagia in women without von Willebrand disease. Data on the risk of surgical bleeding in women with von Willebrand disease are limited, with only 3 studies with a total of 29 patients identified. Data on the effectiveness of specific therapies are also limited; only one controlled trial was identified. Of single tests for screening, one study of the ristocetin cofactor assay had a sensitivity of 79% and specificity of 90%. Studies of a test of platelet adhesion and aggregation resulted in pooled sensitivities of 83–94% and specificities of 80–88%; however, significant heterogeneity was present. CONCLUSION: There are inadequate data to justify routine testing for von Willebrand disease in adult women with Menorrhagia outside of the research setting. LEVEL OF EVIDENCE: II-2
Claire S Philipp - One of the best experts on this subject based on the ideXlab platform.
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von willebrand factor for Menorrhagia a survey and literature review
Haemophilia, 2016Co-Authors: Margaret V Ragni, Andra H James, Claire S Philipp, Nicoletta Machin, Lynn M Malec, Craig M Kessler, B A Konkle, Peter A Kouides, Anne T Neff, Donald BrambillaAbstract:Background von Willebrand disease (VWD) is the most common congenital bleeding disorder. In women, Menorrhagia is the most common bleeding symptom, and is disabling with iron deficiency anaemia, high health cost and poor quality of life. Current hormonal and non-hormonal therapies are limited by ineffectiveness and intolerance. Few data exist regarding von Willebrand factor (VWF), typically prescribed when other treatments fail. The lack of effective therapy for Menorrhagia remains the greatest unmet healthcare need in women with VWD. Better therapies are needed to treat women with Menorrhagia. Methods We conducted a survey of US haemophilia treatment centres (HTCs) and a literature review using medical subject heading (MeSH) search terms ‘von Willebrand factor,’ ‘Menorrhagia’ and ‘von Willebrand disease’ to assess the use of VWF in Menorrhagia. Analysis was by descriptive statistics. Results Of 83 surveys distributed to HTC MDs, 20 (24.1%) provided sufficient data for analysis. Of 1321 women with VWD seen during 2011–2014, 816 (61.8%) had Menorrhagia, for which combined oral contraceptives, tranexamic acid and desmopressin were the most common first-line therapies for Menorrhagia, whereas VWF was third-line therapy reported in 13 women (1.6%). Together with data from 88 women from six published studies, VWF safely reduced Menorrhagia in 101 women at a dose of 33–100 IU kg−1 on day 1–6 of menstrual cycle. Conclusions This represents the largest VWD Menorrhagia treatment experience to date. VWF safely and effectively reduces Menorrhagia in women with VWD. A prospective clinical trial is planned to confirm these findings.
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antifibrinolytics in women with Menorrhagia
Thrombosis Research, 2011Co-Authors: Claire S PhilippAbstract:Heavy menstrual bleeding is associated with increased local fibrinolysis. Antifibrinolytic agents have been used in women with Menorrhagia with and without bleeding disorders, and have been demonstrated to decrease menstrual blood flow approximately 50% and improve quality of life. Most studies have been done with the antifibrinolytic agent tranexamic acid, a synthetic lysine derivative. Studies have been performed comparing tranexamic acid with placebo, non-steroidal anti-inflammatory agents, and progesterone in women with Menorrhagia and have predominantly demonstrated a greater reduction in menstrual blood flow with tranexamic acid. In women with Menorrhagia and an underlying bleeding disorder, tranexamic acid was compared to intranasal desmopressin and also demonstrated a greater reduction in menstrual blood flow. In aggregate the studies demonstrate that antifibrinolytic agents are effective medical management for women with Menorrhagia with or without bleeding disorders, reducing menstrual blood flow and improving quality of life.
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age and the prevalence of bleeding disorders in women with Menorrhagia
Obstetrics & Gynecology, 2005Co-Authors: Claire S Philipp, Anne Dilley, Connie H. Miller, Bruce L Evatt, Ambarina Faiz, Nicole F Dowling, Lisa A Michaels, Charletta Ayers, Gloria Bachmann, Parvin SaidiAbstract:OBJECTIVE: A study was conducted to evaluate the frequency and types of hemostatic defects occurring in adolescent and perimenopausal-age women diagnosed with Menorrhagia. METHODS: A total of 115 women with a physician diagnosis of Menorrhagia, including 25 adolescent women, 25 perimenopausal-age women, and 65 women between the ages of 20 and 44, underwent comprehensive hemostatic testing for possible bleeding disorders. Frequencies of bleeding disorders were calculated and compared. RESULTS: Forty-seven percent of women were found to have hemostatic abnormalities, including platelet dysfunction, von Willebrand's disease, and coagulation factor deficiencies. Adolescents and perimenopausal-age women with Menorrhagia were just as likely to have hemostatic abnormalities as were women aged 20 to 44. CONCLUSION: These results demonstrate that underlying bleeding disorders are frequently found in adolescent, postadolescent reproductive age, and perimenopausal-age women presenting with Menorrhagia and suggest that women with Menorrhagia should be considered for further hemostatic evaluation.
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Age and the Prevalence of Bleeding Disorders in Women Presenting with Menorrhagia.
Blood, 2004Co-Authors: Claire S Philipp, Anne Dilley, Connie H. Miller, Bruce L Evatt, Ambarina Faiz, Nicole F Dowling, Lisa A Michaels, Charletta Ayers, Gloria Bachmann, Parvin SaidiAbstract:Menorrhagia occurring during adolescence and perimenopause is presumed to be associated with anovulation, and during perimenopause, with uterine pathology, such as subserosal uterine myoma, as well. The frequency of bleeding disorders in women presenting with Menorrhagia at the extremes of menstruating age, ie adolescence and perimenopause, are not known. We conducted a study to evaluate the frequency and types of hemostatic defects found in adolescent and perimenopausal age women diagnosed with Menorrhagia. 115 women with a physician diagnosis of Menorrhagia, including 25 adolescent women, 25 perimenopausal age women, and 65 women between the ages of 20 and 44, underwent comprehensive hemostatic testing for possible bleeding disorders. There were no significant differences between the three age groups in mean hemoglobin, percentage of women with anemia, duration of menses, mean pictorial blood assessment scores, or race. Overall, 48% of women were found to have hemostatic abnormalities. Hemostatic abnormalities among women with Menorrhagia Adolescents and perimenopausal age women diagnosed with Menorrhagia were as likely as women presenting between age 20 to 44 to have underlying hemostatic defects. Among the adolescents, neither age at presentation nor time from menarche were predictive of having a bleeding disorder. The platelet aggregation defects observed were similar among the three age groups with the exception of ADP induced platelet aggregation defects which were seen significantly more frequently in adolescents compared to older women (p≤ 0.01). Ristocetin and epinephrine induced platelet aggregation defects were the most common aggregation defects in women 20 years and older and ADP induced platelet aggregation defects were the most common among adolescents. There were no significant differences in platelet ATP release abnormalities between the three age groups. Our results demonstrate that a high proportion of adolescents and perimenopausal age women presenting with Menorrhagia have bleeding disorders. These results suggest that Menorrhagia in the adolescent, even if presenting soon after onset of menarche, and in perimenopausal age women, even if fibroids are present, may warrant hemostatic evaluation. Further age-specific studies evaluating treatment benefits and outcomes in women with Menorrhagia diagnosed with bleeding disorders are warranted.
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platelet functional defects in women with unexplained Menorrhagia
Journal of Thrombosis and Haemostasis, 2003Co-Authors: Claire S Philipp, Anne Dilley, Connie H. Miller, Bruce L Evatt, Gloria Bachmann, A Baranwal, R Schwartz, Parvin SaidiAbstract:Summary. Menorrhagia is a common clinical problem and is unexplained in more than 50% of women. Although studies suggest that von Willebrand's Disease (VWD) is found in a substantial number of women with unexplained Menorrhagia, the prevalence of platelet defects in women with Menorrhagia is unknown. To determine the prevalence of platelet and other hemostatic defects, we evaluated women ages 17–55 diagnosed with unexplained Menorrhagia. Seventy-four women (52 white, 16 black, six other) were studied. Bleeding time was prolonged in 23 women (31.5%). Maximal percent platelet aggregation was decreased with one or more agonists in 35 (47.3%) women. The most commonly found platelet function defects were reduced aggregation responses to ristocetin in 22 women and to epinephrine in 16 women. Sixteen of 22 women with reduced ristocetin aggregation had von Willebrand ristocetin cofactor (VWF:RCo) and von Willebrand factor antigen (VWF:Ag) > 60%. Platelet ATP release was decreased with one or more agonists in 43 (58.1%) women. Of the black women studied, 11/16 (69%) had abnormal platelet aggregation studies compared with 20/52 white women (39%) (P = 0.06). Black women with Menorrhagia had a higher prevalence of decreased platelet aggregation in response to ristocetin and epinephrine than did white women (P = 0.0075, P = 0.02). Ten women (13.5%) had VWF:RCo and/or VWF:Ag < 60%. Using race and blood group specific ranges, 5 (6.8%) women had decreased VWF:RCo, VWF:Ag and/or collagen binding (VWF:CB). Mild factor XI deficiency was found in two women and one woman with mild factor V deficiency and one hemophilia A carrier were identified. We conclude that the prevalence of platelet function defects and other inherited bleeding disorders is substantial in a multiracial US population of women with unexplained Menorrhagia.
Bruce L Evatt - One of the best experts on this subject based on the ideXlab platform.
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age and the prevalence of bleeding disorders in women with Menorrhagia
Obstetrics & Gynecology, 2005Co-Authors: Claire S Philipp, Anne Dilley, Connie H. Miller, Bruce L Evatt, Ambarina Faiz, Nicole F Dowling, Lisa A Michaels, Charletta Ayers, Gloria Bachmann, Parvin SaidiAbstract:OBJECTIVE: A study was conducted to evaluate the frequency and types of hemostatic defects occurring in adolescent and perimenopausal-age women diagnosed with Menorrhagia. METHODS: A total of 115 women with a physician diagnosis of Menorrhagia, including 25 adolescent women, 25 perimenopausal-age women, and 65 women between the ages of 20 and 44, underwent comprehensive hemostatic testing for possible bleeding disorders. Frequencies of bleeding disorders were calculated and compared. RESULTS: Forty-seven percent of women were found to have hemostatic abnormalities, including platelet dysfunction, von Willebrand's disease, and coagulation factor deficiencies. Adolescents and perimenopausal-age women with Menorrhagia were just as likely to have hemostatic abnormalities as were women aged 20 to 44. CONCLUSION: These results demonstrate that underlying bleeding disorders are frequently found in adolescent, postadolescent reproductive age, and perimenopausal-age women presenting with Menorrhagia and suggest that women with Menorrhagia should be considered for further hemostatic evaluation.
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Age and the Prevalence of Bleeding Disorders in Women Presenting with Menorrhagia.
Blood, 2004Co-Authors: Claire S Philipp, Anne Dilley, Connie H. Miller, Bruce L Evatt, Ambarina Faiz, Nicole F Dowling, Lisa A Michaels, Charletta Ayers, Gloria Bachmann, Parvin SaidiAbstract:Menorrhagia occurring during adolescence and perimenopause is presumed to be associated with anovulation, and during perimenopause, with uterine pathology, such as subserosal uterine myoma, as well. The frequency of bleeding disorders in women presenting with Menorrhagia at the extremes of menstruating age, ie adolescence and perimenopause, are not known. We conducted a study to evaluate the frequency and types of hemostatic defects found in adolescent and perimenopausal age women diagnosed with Menorrhagia. 115 women with a physician diagnosis of Menorrhagia, including 25 adolescent women, 25 perimenopausal age women, and 65 women between the ages of 20 and 44, underwent comprehensive hemostatic testing for possible bleeding disorders. There were no significant differences between the three age groups in mean hemoglobin, percentage of women with anemia, duration of menses, mean pictorial blood assessment scores, or race. Overall, 48% of women were found to have hemostatic abnormalities. Hemostatic abnormalities among women with Menorrhagia Adolescents and perimenopausal age women diagnosed with Menorrhagia were as likely as women presenting between age 20 to 44 to have underlying hemostatic defects. Among the adolescents, neither age at presentation nor time from menarche were predictive of having a bleeding disorder. The platelet aggregation defects observed were similar among the three age groups with the exception of ADP induced platelet aggregation defects which were seen significantly more frequently in adolescents compared to older women (p≤ 0.01). Ristocetin and epinephrine induced platelet aggregation defects were the most common aggregation defects in women 20 years and older and ADP induced platelet aggregation defects were the most common among adolescents. There were no significant differences in platelet ATP release abnormalities between the three age groups. Our results demonstrate that a high proportion of adolescents and perimenopausal age women presenting with Menorrhagia have bleeding disorders. These results suggest that Menorrhagia in the adolescent, even if presenting soon after onset of menarche, and in perimenopausal age women, even if fibroids are present, may warrant hemostatic evaluation. Further age-specific studies evaluating treatment benefits and outcomes in women with Menorrhagia diagnosed with bleeding disorders are warranted.
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platelet functional defects in women with unexplained Menorrhagia
Journal of Thrombosis and Haemostasis, 2003Co-Authors: Claire S Philipp, Anne Dilley, Connie H. Miller, Bruce L Evatt, Gloria Bachmann, A Baranwal, R Schwartz, Parvin SaidiAbstract:Summary. Menorrhagia is a common clinical problem and is unexplained in more than 50% of women. Although studies suggest that von Willebrand's Disease (VWD) is found in a substantial number of women with unexplained Menorrhagia, the prevalence of platelet defects in women with Menorrhagia is unknown. To determine the prevalence of platelet and other hemostatic defects, we evaluated women ages 17–55 diagnosed with unexplained Menorrhagia. Seventy-four women (52 white, 16 black, six other) were studied. Bleeding time was prolonged in 23 women (31.5%). Maximal percent platelet aggregation was decreased with one or more agonists in 35 (47.3%) women. The most commonly found platelet function defects were reduced aggregation responses to ristocetin in 22 women and to epinephrine in 16 women. Sixteen of 22 women with reduced ristocetin aggregation had von Willebrand ristocetin cofactor (VWF:RCo) and von Willebrand factor antigen (VWF:Ag) > 60%. Platelet ATP release was decreased with one or more agonists in 43 (58.1%) women. Of the black women studied, 11/16 (69%) had abnormal platelet aggregation studies compared with 20/52 white women (39%) (P = 0.06). Black women with Menorrhagia had a higher prevalence of decreased platelet aggregation in response to ristocetin and epinephrine than did white women (P = 0.0075, P = 0.02). Ten women (13.5%) had VWF:RCo and/or VWF:Ag < 60%. Using race and blood group specific ranges, 5 (6.8%) women had decreased VWF:RCo, VWF:Ag and/or collagen binding (VWF:CB). Mild factor XI deficiency was found in two women and one woman with mild factor V deficiency and one hemophilia A carrier were identified. We conclude that the prevalence of platelet function defects and other inherited bleeding disorders is substantial in a multiracial US population of women with unexplained Menorrhagia.
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von willebrand disease and other inherited bleeding disorders in women with diagnosed Menorrhagia
Obstetrics & Gynecology, 2001Co-Authors: Anne Dilley, Cathy Lally, Harland Austin, Donna Ramaswamy, Donald Lurye, Connie H. Miller, Carolyn Drews, Bruce L EvattAbstract:Abstract Objective: To estimate the prevalence of von Willebrand disease and other bleeding disorders in women with and without diagnosed Menorrhagia. Methods: Women with Menorrhagia were identified among members of a health maintenance organization in the southeastern United States through a computer search for appropriate International Classification of Diseases, 9th Revision codes. A random sample of members with no such code was selected as controls. The study included 121 women with Menorrhagia and 123 controls. Subjects were interviewed in person, and blood was drawn for coagulation testing. Laboratory results for Menorrhagia patients were compared with those in controls using race and blood type specific ranges developed from the control group. A test was considered abnormal if it exceeded two standard deviations below the control mean. Results: Bleeding disorders (von Willebrand disease, factor deficiency, or a platelet abnormality) were diagnosed in 10.7% of Menorrhagia patients and 3.2% of controls (P = .02). von Willebrand disease was present in eight Menorrhagia patients (6.6%) and in one control (0.8%) (P = .02); separate analyses by race revealed a von Willebrand disease prevalence of 15.9% among white and 1.4% among black Menorrhagia patients (P = .01). Women with bleeding disorders did not differ significantly from controls in other symptoms of bleeding. Conclusion: The prevalence of inherited bleeding disorders among white women with Menorrhagia was substantial, consistent with European data published recently. For unknown reasons, the prevalence of von Willebrand disease was lower among black women. These findings indicate the importance of considering inherited bleeding disorders as a cause of Menorrhagia.
R A Kadir - One of the best experts on this subject based on the ideXlab platform.
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Menorrhagia in adolescents with inherited bleeding disorders
Journal of Pediatric and Adolescent Gynecology, 2010Co-Authors: Debra Pollard, Edward G D Tuddenham, R A KadirAbstract:Abstract Study Objectives We reviewed the management and treatment outcomes of Menorrhagia in adolescents with inherited bleeding disorders and assessed the impact of Menorrhagia on their quality of life. Design Retrospective review of case notes and a questionnaire study. Setting Comprehensive-care hemophilia treatment center. Participants Adolescents with inherited bleeding disorders who had registered at the center and were attending the multidisciplinary hemophilia and gynecology clinic for management of Menorrhagia. Interventions Review of medical records and assessment of menstrual blood loss using the pictorial blood assessment chart and quality of life measurements during menstruation using a questionnaire. Main Outcome Measures Scores on pictorial blood assessment charts and quality of life measurements before and after treatment. Results Of 153 girls aged 12 to 19 years who had registered at the center and had an inherited bleeding disorder, 42 (27%) attended the multidisciplinary clinic for management of Menorrhagia. The majority (38/42; 90%) had experienced Menorrhagia since menarche. Of the group, 5 (12%) required hospital admission for acute Menorrhagia and severe anemia. Treatment options for Menorrhagia included tranexamic acid, desmopressin, combined oral contraceptive pills, clotting factor concentrate, and the levonorgestrel intrauterine system. These treatment modalities, alone or in combination, were associated with a reduction in menstrual blood loss (median pre- and posttreatment pictorial blood assessment chart scores were 215 and 88, respectively) and improvement in quality of life scores (median pre- and posttreatment were 26 and 44, respectively). Conclusions Menorrhagia is a common symptom in adolescents with inherited bleeding disorders. It can present acutely, and it adversely affects quality of life. Treatment options include hemostatic and/or hormonal therapies and can improve the quality of life of affected girls.
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review of quality of life Menorrhagia in women with or without inherited bleeding disorders
Haemophilia, 2007Co-Authors: M Shankar, R A KadirAbstract:Summary. The objectives of this study were to identify the impact of Menorrhagia on the health-related quality of life (HRQOL) of women in general and those with inherited bleeding disorders and to identify the commonly used tools in assessing quality of life. A review of studies evaluating quality of life in women suffering from Menorrhagia was conducted. Data sources used included electronic databases Medline and Embase. Reference lists and bibliographies of the relevant papers and books were hand-searched for additional studies. Eighteen of the 53 studies identified measured quality of life prior to treatment of Menorrhagia. Ten of the studies used a validated measure of quality of life. Five studies involving a total of 1171 women with Menorrhagia in general and using SF-36 were considered for further review. The mean SF-36 scores in women with Menorrhagia were worse in all the eight scales when compared with normative scores from a general population of women. Three studies, involving 187 women, assessed the quality of life in women with Menorrhagia and inherited bleeding disorders. None of these studies used a validated HRQOL score making it difficult for comparison. However, all reported poorer scores in study women compared to the controls. In conclusion, HRQOL is adversely affected in women with Menorrhagia in general and in those with inherited bleeding disorders. HRQOL evaluation is useful in the management of women with Menorrhagia for assessment of treatment efficacy.
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von willebrand disease in women with Menorrhagia a systematic review
British Journal of Obstetrics and Gynaecology, 2004Co-Authors: Meena Shankar, Caroline Sabin, Demetrios L. Economides, R A KadirAbstract:OBJECTIVE: To determine the prevalence of von Willebrand disease in women presenting with Menorrhagia. DESIGN: Systematic review of studies evaluating the prevalence of von Willebrand disease in women with Menorrhagia. SETTING: Hospital outpatient clinics (mainly gynaecological) and population surveys. POPULATION: Women presenting with Menorrhagia. METHODS: Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences. MAIN OUTCOME MEASURES: Number of women with von Willebrand disease. RESULTS: Eleven studies were included, totalling 988 women with Menorrhagia. One hundred and thirty-one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% CI 11-15.6%). The prevalence was higher in the European studies-18% (95% CI 15-23%) compared with that in North American studies-10% (95% CI 7.5-13%). This difference (P= 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race- and ABO blood group-specific values for von Willebrand factor. CONCLUSIONS: The prevalence of von Willebrand disease is increased in women with Menorrhagia and is the underlying cause in a small but significant group of women with Menorrhagia across the world. Testing for this disorder should be considered when investigating women with Menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms.
Peter A Kouides - One of the best experts on this subject based on the ideXlab platform.
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von willebrand factor for Menorrhagia a survey and literature review
Haemophilia, 2016Co-Authors: Margaret V Ragni, Andra H James, Claire S Philipp, Nicoletta Machin, Lynn M Malec, Craig M Kessler, B A Konkle, Peter A Kouides, Anne T Neff, Donald BrambillaAbstract:Background von Willebrand disease (VWD) is the most common congenital bleeding disorder. In women, Menorrhagia is the most common bleeding symptom, and is disabling with iron deficiency anaemia, high health cost and poor quality of life. Current hormonal and non-hormonal therapies are limited by ineffectiveness and intolerance. Few data exist regarding von Willebrand factor (VWF), typically prescribed when other treatments fail. The lack of effective therapy for Menorrhagia remains the greatest unmet healthcare need in women with VWD. Better therapies are needed to treat women with Menorrhagia. Methods We conducted a survey of US haemophilia treatment centres (HTCs) and a literature review using medical subject heading (MeSH) search terms ‘von Willebrand factor,’ ‘Menorrhagia’ and ‘von Willebrand disease’ to assess the use of VWF in Menorrhagia. Analysis was by descriptive statistics. Results Of 83 surveys distributed to HTC MDs, 20 (24.1%) provided sufficient data for analysis. Of 1321 women with VWD seen during 2011–2014, 816 (61.8%) had Menorrhagia, for which combined oral contraceptives, tranexamic acid and desmopressin were the most common first-line therapies for Menorrhagia, whereas VWF was third-line therapy reported in 13 women (1.6%). Together with data from 88 women from six published studies, VWF safely reduced Menorrhagia in 101 women at a dose of 33–100 IU kg−1 on day 1–6 of menstrual cycle. Conclusions This represents the largest VWD Menorrhagia treatment experience to date. VWF safely and effectively reduces Menorrhagia in women with VWD. A prospective clinical trial is planned to confirm these findings.
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evaluation and management of acute Menorrhagia in women with and without underlying bleeding disorders consensus from an international expert panel
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011Co-Authors: Andra H James, Jennifer E. Dietrich, Peter A Kouides, Rezan Abdulkadir, Mans Edlund, Augusto B Federici, Susan Halimeh, Pieter Willem Kamphuisen, Oscar Martinezperez, Claire MclintockAbstract:Abstract Acute Menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology reached consensus on recommendations regarding the management of acute Menorrhagia in women without a diagnosed bleeding disorder, as well as in patients with von Willebrand disease, platelet function disorders and other rare hemostatic disorders. The causes and predictors of acute Menorrhagia are discussed and special consideration is given for the treatment of women on anticoagulation therapy. This review and accompanying recommendations will provide guidance for healthcare practitioners in the emergency management of acute Menorrhagia.
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Platelet Dense Granule Deficiency is Associated with Menorrhagia.
Blood, 2009Co-Authors: Josh Sham, William T. Gunning, Laura Braggins, Ronald L. Sham, Peter A KouidesAbstract:Abstract 1327 Poster Board I-349 Outpatient evaluation of hemostasis for women with Menorrhagia and/or other bleeding symptoms can be unrevealing. A candidate etiology in some of these patients may be platelet (PL) dense granule (DG) deficiency, a heterogeneous bleeding diathesis characterized by variable abnormalities in platelet aggregation and decreased DG number and/or decreased DG volume by electron microscopy (EM) and image analysis. Objective To determine the correlation between Menorrhagia and the number and volume of platelet DGs in a cohort of women participating in a multi-center Menorrhagia treatment study (British J Haem 145(2):212-220, 2009). Patients and Methods The diagnosis of Menorrhagia was determined using a semi-objective pictorial blood assessment chart (PBAC) necessitating a score of >100. The Menorrhagia patients were compared to control subjects, evaluated as paired subjects on the same day. A total of 29 pairs were studied. Patients were eligible only if gynecological exam was normal. All patients were tested for other underlying hemostatic defects. Hemostatic disorders included: a platelet function disorder in 7/29 (24%), a coagulation factor deficiency 2/29 (7%) and von Willebrand disease 1/29 (3%). Results The mean age of the Menorrhagia group was 35 ± 6.07 years. These patients had an average PBAC score of 454 ± 302.6 Patients were found to have a mean of 2.910 ± 1.207 DG/PL compared to 4.617 ± 1.13 DG/PL for the control group (p-value Conclusions Patients with Menorrhagia with and without other hemostatic defects, had fewer platelet DGs than the control group. In addition, the aggregate DG volume/PL was significantly reduced in Menorrhagia patients compared to the control group. These findings suggest that the Menorrhagia experienced by some women is associated with platelet DG deficiency. Further study is needed in determining the significance of these findings. Disclosures No relevant conflicts of interest to declare.
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von willebrand disease and other bleeding disorders in women consensus on diagnosis and management from an international expert panel
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Andra H James, Peter A Kouides, Rezan Abdulkadir, Mans Edlund, Augusto B Federici, Susan Halimeh, Pieter Willem Kamphuisen, Oscar Martinezperez, Barbara A Konkle, Claire MclintockAbstract:Reproductive tract bleeding in women is a naturally occurring event during menstruation and childbirth. In women with Menorrhagia, however, congenital bleeding disorders historically have been underdiagnosed. This consensus is intended to allow physicians to better recognize bleeding disorders as a cause of Menorrhagia and consequently offer effective disease-specific therapies.
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6B.1 Menorrhagia and von Willebrand disease
Thrombosis Research, 2007Co-Authors: Peter A KouidesAbstract:Introduction The past decade has been a very productive period of clinical research in von Willebrand disease (VWD) in women. Though the topic is relatively broad including obstetrical issues and menstrual issues unrelated to Menorrhagia, we will focus on the major issue being Menorrhagia. The reader is also referred to a recent very comprehensive and well-written review in the form of United Kingdom guidelines authored by Lee et al. [1]. Table 1 summarizes the present body of data in VWD-related Menorrhagia in terms of what is known and what is deserving of future study.
