Bleeding Disorders Significantly Impact Quality of Life Among Women
Researchers analyzed historical characteristics of bleeding disorders among women by highlighting clinical challenges and management strategies.
Because of their sex-specific nature, hereditary bleeding disorders are most prominent and create significant impacts on the quality of life (QOL) of women and girls, according to data published in Hämostaseologie.1 Researchers identified significant complications leading to underdiagnosis and undertreatment of bleeding disorders among women and suggested further advocacy, research, and education of these hereditary conditions.
“The bleeding phenotype among men and women is similar, although it is more common for women to be referred for issues related to bleeding, and they often require more frequent and more extensive treatment due to the presence of sex-specific bleeding patterns,” wrote the authors. “Indeed, women are exposed to a multitude of bleeding challenges throughout their lives such as heavy menstrual bleeding (HMB) on a monthly basis, excessive bleeding during miscarriages, postpartum hemorrhage, and hemorrhagic ovarian cysts.”
March is Bleeding Disorders Awareness Month. | image credit: SR07XC3 / stock.adobe.com
Women’s genetic nature makes them much more familiar with bleeding disorders and symptoms than their male counterparts. But before exploring bleeding disorders by separating women from men, it’s important to know what they are and how they impact the human body.
READ MORE: Exploring the Impact of COVID-19 on Menstrual Health, Pregnancy Outcomes | IDWeek 2024
Bleeding disorders can be inherited at birth (hereditary) or acquired during a patient’s life; the latter of which is more common, according to the National Heart, Lung, and Blood Institute.2
Hereditary bleeding disorders are presented as a group of hemostasis defects that impact a patient’s blood-clotting process. The most prominent of all bleeding disorders are von Willebrand disease (VWD) and hemophilia A and B—all 3 of which are hereditary. There are also rare bleeding disorders (RBDs) that affect about 9% of all patients with any type of bleeding disorder.1
“Women with inherited bleeding disorders experience a variety of bleeding symptoms, before, during, and after their reproductive years,” continued authors of the study. “In a recent survey conducted by the European Hemophilia Consortium, 709 women with inherited bleeding disorders reported epistaxis, bruising, muscle hematoma, and hemarthroses, depending on the severity of the hemostasis defect.”
With a significant lack of evidence regarding the outcomes of women with bleeding disorders, researchers were led to explore HMB treatment and the persistent challenges this population group faces. The goal of their review was to “provide a comprehensive summary of the distinctive characteristics of hereditary bleeding disorders in women, with a particular focus on HMB and other gynecological clinical challenges.”1
HMB is considered excessive menstrual blood loss hindering a patient’s QOL and it impacts as many as 90% of women that have had previous blood disorder diagnoses. However, researchers found that HMB may be leading to underdiagnosis of hereditary bleeding disorders. Because most women’s HMB is often treated without testing, bleeding disorders may be going underdiagnosed.
“In the ‘Rare Bleeding Disorders in the Netherlands’ (RBiN) study, despite the presence of HMB since menarche, the diagnosis of a hereditary bleeding disorder was made at the age of 28 years on average,” they continued. “Thus, it appears evident that the correlation between HMB and hereditary bleeding disorders remains insufficiently acknowledged.”
Next, the researchers suggested that all women and girls with HMB be evaluated with full historical and diagnostic testing. While they also suggested women with HMB to see a hematologist, study authors advised providers to follow a specific set of steps if there is clinical suspicion that a patient has a bleeding disorder. These steps included providing a Pictorial Blood-loss Assessment Chart (PBAC) for the patient, an International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH-BAT) score, extensive family history, a clinical examination, and specialized laboratory testing.1
Finally, researchers mentioned the 2 types of pharmacological agents used to treat HMB and hereditary bleeding disorders in women—hormonal and hemostatic therapies.
Hormonal therapies have been used as an effective method for treating HMB because of their ability to stabilize and reduce endometrium thickness. Hemostatic therapies, used either on their own or with hormonal therapies, include antifibrinolytics, desmopressin, and factor or non-factor replacement therapies. Nonsteroidal anti-inflammatory drugs were not recommended because of their antiplatelet effects,1 despite their ability to make menstrual cramps less painful.3
“Hereditary bleeding disorders present distinctive challenges for girls and women, largely due to the sex-specific nature of bleeding symptoms that may have a profound impact on the QOL,” they concluded.1 “Effective management requires increased awareness among health care professionals, early diagnosis, and individualized treatment approaches that consider both hormonal and hemostatic options. Addressing these needs has the potential to improve health outcomes for girls and women with bleeding disorders. Continued advocacy, research, and education are essential to ensure equitable care and reduce gender bias in the management of bleeding disorders.”
READ MORE: Women’s Health Resource Center
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