Women can be affected by inherited bleeding disorders that may cause problems with heavy menstrual bleeding (menorrhagia), possible haemorrhage following childbirth and prolonged bleeding following trauma or surgery.
Haemophilia (A or B) is an X linked disorder and presents in males. In 10 - 15% of cases of women, who carry the haemophilia gene, lower levels of Factor VIII in Haemophilia A or Factor IX in Haemophilia B can occur. These lower levels of clotting protein may predispose women to heavy menstrual loss, prolonged bleeding following surgery or bleeding post delivery. Some symptoms may be lessened in surgery and pregnancy as the level of coagulation protein can be increased by the stress of surgery or hormones induced by pregnancy. In those with Haemophilia B (Factor IX), hormones do not increase clotting protein levels.
Von Willebrand's Disorder can affect both sexes and vary from a mild disorder to the occasional severe disorder similar to Haemophilia. Symptoms of von Willebrand's Disorder vary from bruising, frequent blood noses, excessive bleeding from surgery or tooth extractions and heavy menstrual loss (menorrhagia). In 85% of cases, symptoms can be lessened with stress of surgery or hormones including of those affected during pregnancy.
Other less common bleeding disorders can result in similar bleeding problems in females - including Factor XI deficiency and platelet disorders.
Prolonged menstrual bleeding may lead to iron deficiency and anaemia. Tranexamic Acid tablets may be used to minimise bleeding if taken early in the period. The oral contraceptive pill can also be used to minimise bleeding. If these treatments are ineffective there are other options available.
Prior to surgery treatment to increase the level of clotting protein can be performed. DDAVP - an intravenous infusion over 30 mins may be used. If this is ineffective, a clotting factor concentrate may be used in some cases of von Willebrand's Disorder. DDAVP is not useful for Haemophilia B.
Miscarriages and terminations early in pregnancy may result in prolonged bleeding, as the effect of hormones is not as great early in the pregnancy. Bleeding a few days after miscarriage or termination may occur. This may require medical assessment and treatment.
Ensure that your treating obstetrician is aware that you have a bleeding disorder and that they can get further information and assistance from the staff of the Haemophilia Centre.
This page last updated: November 2004
Review date: June 2005
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