Intrauterine device
The Mirena inter-uterine system is a contraceptive device which is fitted inside the uterus. It helps to reduce menstrual blood loss by releasing progesterone which thins the endometrium (uterus lining).Once inserted, Mirena can last for up to five years, after which time it should be changed. Fertility is preserved when the device is removed provided there are no complications.
As with any invasive procedure, it should be discussed first with the haemophilia centre.
Surgical treatments
Hysteroscopic endometrial ablation, which strips off the endometrium, can be used for the treatment of heavy menstrual flow. It is carried out under a general anaesthetic or sedation. The uterus is examined with a narrow telescope (hysteroscope) inserted into the vagina and through the cervix, allowing the doctor to thoroughly examine the endometrium.The endometrium is then ablated by resection, electrical current, laser or microwave energy via the hysteroscope. In most cases, women will no longer be able to have children following the procedure.
Some hospitals may prescribe a course of tablets or injections before this procedure to reduce the thickness of the endometrium. The procedure may involve an overnight stay in hospital, and rest is recommended for at least 24 hours. As with any invasive procedure, the haemophilia centre should be consulted as haemostatic (clotting factor) cover may be necessary.
Pregnancy
Any pregnant woman who is a symptomatic carrier should be cared for by their obstetrician in consultation with a haematologist. All pregnancies carry a small risk of bleeding after delivery, therefore multidisciplinary care is important to minimize the risk. In symptomatic carriers of haemophilia A, levels factor VIII increase during pregnancy but fall immediately after delivery, so there is a risk of post-partum haemorrhage. Factor IX levels do not rise during pregnancy in symptomatic carriers of haemophilia B.Treatment may be necessary to increase factor levels and control bleeding, especially if a caesarean section is required.
It is important for the delivery team to know the sex of the baby before the birth, as a baby boy will have a 50:50 chance of having haemophilia, so this will affect the delivery. If the parents would prefer the sex to be a surprise, this can sometimes be accommodated.
It is very important that instruments such as forceps are not used, because if a baby boy has haemophilia they may cause bleeding into the baby’s head. Ventuose suction must also be avoided for the same reason.
(published with permission in writing from:http://www.womenbleedtoo.org.uk)
