Living with heavy menstrual bleeding

Menstruation, Von Willebrand disease, Genetic, Haemophilia

Every woman is different, so it is impossible to define a “normal” period. Statistically, the average blood loss from a single menstrual period is between 30 – 40 ml. Monthly blood loss of 80ml or above is considered to be heavy in medical terms.

Prolonged and heavy menstrual bleeding is one of the most common symptoms for women with VWD. Some women bleed excessively during their period, others bleed between periods or almost continuously.

Living with heavy periods can have a dramatic effect on health, well-being, employment and relationships, and should not be dismissed as a minor issue. Women who have very heavy menstrual flow may also have headaches, dizziness, fatigue, swollen limbs and bruising. The excessive bleeding can also lead to anaemia, as the blood loss causes the body to lose iron, and iron supplements may be prescribed for this.

Diagnosis and testing

Accurate diagnosis is vital, so that appropriate treatment can be given to control bleeding in the event of an accident, surgery, dental procedure or childbirth. There is no single test to diagnose VWD, and it is important to ask for a referral to a haematologist specialising in bleeding disorders for testing. This is because there are very specific blood tests that should be carried out to diagnose VWD, which will be familiar to the haematologist.

Because VWD is mainly an inherited condition, the doctor or genetic counsellor will take a complete family history, looking at whether family members have had any bleeding symptoms.

Blood tests

There are a number of blood tests to diagnose VWD. They are designed to find out whether the person has VWD, and which type of VWD they have.

Factor VIII:C - this measures the factor VIII clotting activity in the blood
VWF antigen - this measures the actual level of VWF in the blood
VWF activity (ristocetin cofactor activity) - this tests how well the VWF is working, and whether it functions normally
VWF multimers - this measures the structure of the VWF molecules in the blood
Platelet function tests - to measure how well the platelets in the blood are working
Bleeding time test - this test measures how long it takes for a small cut to the skin to stop bleeding. The test is not usually carried out on children

Some of these tests may need to be repeated, as levels of clotting factor can fluctuate, especially in cases of mild VWD when levels may be close to the normal range. There may be a delay of several weeks before all of the results are available.

There are certain conditions which can affect the accuracy of the test results:

if you are under a great deal of stress
if you have been crying or feeling emotional just before the test, including feeling excited or happy
if you have just had surgery
if you are read more