Managing Prolonged Menstrual Bleeding in Patients with Hemophilia

Q: Managing Prolonged Menstrual Bleeding in Patients with Hemophilia

Liz： Hello, since gynecological factors have been ruled out, it is believed that your condition is related to your internal medicine issues. <br>I recommend that you seek care at a major hospital where both the obstetrics and gynecology department and the hematology-oncology depa

Menstrual bleeding has not stopped after 24 days?

Hello Doctor: I have a history of hemophilia, but it has never affected my menstruation until 2019.
Since then, I have experienced heavy menstrual bleeding, sometimes lasting 3-5 days and other times 7-10 days.
This time, my period has lasted for 24 days without stopping.
I have already gone to the emergency room for blood transfusions twice this week.
The first time, I received 5 bags of cryoprecipitate and 500 ml of red blood cells; before the transfusion, my hemoglobin level was measured at 6.1, and I was saturating a 35 cm sanitary pad in about an hour.
The second time, I received two bags of 500 ml of red blood cells, and after the transfusion, I saturated a 35 cm sanitary pad in about two hours (my hemoglobin was also 6.1 before this transfusion).
I have been checked for uterine fibroids, and the doctor confirmed that any old eggs that should have been expelled have been cleared.
However, I am still unable to stop the bleeding.
I am wondering if it is related to accidentally consuming foods with blood-activating properties before my period (such as medicinal hot pot, wood ear mushrooms, and hawthorn cakes).
Currently, my obstetrician-gynecologist has prescribed Tranexamic Acid and Hiccup Pills for me.
After taking Tranexamic Acid, the bleeding only temporarily slows down, but the effect wears off quickly, and the side effects last a long time.
The Hiccup Pills have caused severe side effects; two days ago, after taking one, I experienced intense vomiting and a full-body heat sensation.
Today, after taking one, I had strong cramping menstrual pain that made me break out in cold sweat.
Two weeks ago, I consulted a hematologist, but they only prescribed Tranexamic Acid and Iron Supplements.
Although the Iron Supplements have alleviated some anemia symptoms, the bleeding continues to worsen day by day, and I am at a loss for what to do.
I kindly request your advice.
Thank you for taking the time to respond.

Liz, 20~29 year old female. Ask Date: 2022/06/11

Dr. Lin Manying reply Obstetrics and Gynecology

Liz: Hello, since gynecological factors have been ruled out, it is believed that your condition is related to your internal medicine issues.
I recommend that you seek care at a major hospital where both the obstetrics and gynecology department and the hematology-oncology department can collaborate.
Regarding treatment from the obstetrics and gynecology department, taking contraceptive pills may be an option, and you should discuss with your attending physician whether this is suitable for your health condition.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2022/06/11

More Info

Managing prolonged menstrual bleeding in patients with hemophilia can be particularly challenging due to the underlying coagulopathy that affects the blood's ability to clot. In your case, the history of heavy menstrual bleeding (menorrhagia) since 2019, along with the recent episodes of significant blood loss requiring multiple transfusions, indicates a serious situation that needs immediate attention.

First and foremost, it is essential to understand that hemophilia can lead to complications during menstruation due to the deficiency in clotting factors. This deficiency can result in prolonged bleeding episodes, which can be exacerbated by factors such as hormonal fluctuations, stress, and even certain foods or medications that may have anticoagulant properties. While you mentioned consuming foods with potential blood-thinning effects, it is crucial to focus on the management of your condition rather than attributing the bleeding solely to dietary choices.

Given the severity of your symptoms, including the need for blood transfusions and the low hemoglobin levels (6.1 g/dL), it is imperative to consult with a hematologist who specializes in bleeding disorders. They can evaluate your current treatment plan and consider alternative therapies that may be more effective in managing your bleeding episodes. For instance, desmopressin (DDAVP) is sometimes used in patients with mild hemophilia A to stimulate the release of von Willebrand factor and factor VIII, which can help improve clotting. However, this treatment is not suitable for all types of hemophilia, so a thorough assessment is necessary.

In addition to pharmacological interventions, your healthcare provider may consider the use of hormonal therapies to help regulate your menstrual cycle and reduce the frequency and severity of bleeding. Birth control pills, hormonal IUDs, or other hormonal treatments can be effective in managing menorrhagia in women with bleeding disorders. These options can help stabilize the endometrial lining and reduce the amount of menstrual flow.

Furthermore, it is essential to monitor your iron levels and overall nutritional status, especially given the significant blood loss you have experienced. Iron supplementation may be necessary to address any anemia resulting from prolonged bleeding. Your healthcare provider can guide you on the appropriate dosage and type of iron supplement to take.

Regarding the side effects you are experiencing from the medications prescribed, it is crucial to communicate these concerns with your healthcare provider. They may need to adjust your treatment plan or explore alternative medications that may have a more favorable side effect profile. The discomfort and adverse reactions you are experiencing should not be overlooked, as they can significantly impact your quality of life.

In summary, managing prolonged menstrual bleeding in patients with hemophilia requires a comprehensive approach that includes:
1. Consultation with a hematologist: To evaluate your bleeding disorder and adjust your treatment plan accordingly.

2. Consideration of hormonal therapies: To help regulate your menstrual cycle and reduce bleeding.

3. Monitoring and managing anemia: Through iron supplementation and dietary adjustments.

4. Open communication with your healthcare providers: To address any side effects from medications and ensure that your treatment plan is effective and tolerable.

Given the complexity of your situation, it is crucial to seek specialized care and not hesitate to advocate for your health needs. If your symptoms persist or worsen, do not hesitate to return to the emergency department or seek immediate medical attention. Your health and well-being are paramount, and timely intervention can help prevent further complications.

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