Abnormalities of Hemostasis and Abnormal Uterine Bleeding

Introduction The connection between abnormalities of hemostasis and abnormal uterine bleeding appears to be an obvious one, but only recently have there been designated prioritized research efforts to define and quantify this relationship. A woman who presented to her gynecologist with a history of excessive bleeding during a menstrual cycle would be evaluated for local abnormalities or hormonal influences; a bleeding disorder has been low on the differential list. Simultaneously, women with bleeding disorders have been describing menorrhagia to their hematologists, and it has been accepted as one of the clinical symptoms of the disorder. The connection between the 2 disorders was well chronicled almost 40 years ago by Dr. Armand Quick, but further study did not follow until 30 years later. Dr. Quick developed the prothrombin time test and an earlier version of the partial thromboplastin time test used to diagnosis many of the bleeding disorders. The prothrombin time test has been used since that time as a reliable method to monitor the use of coumarins. Dr. Quick was also one of the first to describe the bleeding complications of aspirin. A less recognized publication is his review article called Menstruation in Hereditary Bleeding Disorders. In his article, there are many statements that still apply and will be quoted in this chapter. Although menorrhagia can occur with acquired abnormalities of hemostasis, inherited bleeding disorders will be the focus of this discussion. This chapter will describe the diagnosis, evaluation, and management of menorrhagia from the perspective of the hematology specialist. We will review the abnormalities of hemostasis that impact on women during the menstrual cycle, describe the laboratory testing required for Correspondence: Jamie E. Siegel, MD, Director of Hemophilia and Thrombosis Center, Medical Director of the Cardeza Foundation Special Hemostasis Laboratory, Cardeza Foundation for Hematologic Research and Division of Hematology, Thomas Jefferson University, 111 S. 11th Street, 4225 Gibbon, Philadelphia, PA 19107. E-mail: Jamie.Siegel@jefferson.edu