How I treat heavy menstrual bleeding associated with anticoagulants

Blood. 2017 Dec 14;130(24):2603-2609. doi: 10.1182/blood-2017-07-797423. Epub 2017 Nov 1.

Abstract

Anticoagulant-associated heavy menstrual bleeding (HMB) is an underrecognized but not uncommon problem in clinical practice. Premenopausal women should be advised of the potential effect of anticoagulant therapy on menstrual bleeding at the time of treatment initiation. Consequences of HMB should be assessed and treated on an ongoing basis. In the acute setting, the decision to withhold anticoagulants is based on an individual patient's risk of thrombosis and the severity of the bleeding. For women who require long-term anticoagulation, a levonorgestrel intrauterine system, tranexamic acid (during menstrual flow), high-dose progestin-only therapy, or combined hormonal contraceptives are effective for controlling HMB. The risk of thrombosis during anticoagulant therapy with these treatments is not well studied but is likely to be low. Selection of type of hormonal therapy is based on patient preference, other indications for and contraindications to therapy, adverse effect profile, and ongoing thrombotic risk factors. Women who do not respond to medical treatment or who do not wish to retain their fertility should be considered for surgical management.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Antifibrinolytic Agents / therapeutic use
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Menorrhagia / chemically induced
  • Menorrhagia / drug therapy*
  • Practice Guidelines as Topic
  • Pulmonary Embolism / drug therapy
  • Rivaroxaban / adverse effects
  • Rivaroxaban / therapeutic use
  • Tranexamic Acid / therapeutic use*
  • Treatment Outcome
  • Venous Thromboembolism / drug therapy
  • Young Adult

Substances

  • Anticoagulants
  • Antifibrinolytic Agents
  • Tranexamic Acid
  • Rivaroxaban