Screening for underlying bleeding disorders in women with menorrhagia

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Abstract
Objective: Menorrhagia, excessive menstrual bleeding, affects up to 20% of reproductive-aged women. Underlying bleeding disorders, such as von Willebrand’s disease (vWD) and platelet abnormalities, may present as menorrhagia. Gynecologists do not routinely screen women with menorrhagia for bleeding disorders. The purpose of this preliminary study was to detect underlying bleeding disorders in women with menorrhagia using a new screening test. Methods: Reproductive-aged women with a diagnosis of menorrhagia were identified. Participants were screened using the PFA-100 (Dade Behring, Inc., Miami, FL), an in vitro platelet function analyzer found to be both sensitive (95%) and specific (88%) in the detection of vWD and platelet disorders. A positive test result was defined as prolonged time until clot formation. Results were confirmed with additional testing. Results: During the first 8 months of the study, 43 women were enrolled. The median age was 40 years. Twenty-one (49%) were white, 21 (49%) were African American, and 1 (2%) was Asian. Sixteen of the 43 women had a positive PFA-100 test result. Eleven had positive results suggestive of aspirin use. Five (12%) were found to have an underlying bleeding disorder: two with vWD and three with platelet abnormalities. Conclusions: Our preliminary findings suggest that the PFA-100 is useful in the evaluation of women with menorrhagia. A significant number of these women appear to have underlying bleeding disorders.

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