Publication: How I treat heavy menstrual bleeding associated with anticoagulants
Issued Date
2017-12-14
Resource Type
ISSN
15280020
00064971
00064971
Other identifier(s)
2-s2.0-85038403494
Rights
Mahidol University
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SCOPUS
Bibliographic Citation
Blood. Vol.130, No.24 (2017), 2603-2609
Suggested Citation
Kochawan Boonyawat, Sarah H. O’Brien, Shannon M. Bates How I treat heavy menstrual bleeding associated with anticoagulants. Blood. Vol.130, No.24 (2017), 2603-2609. doi:10.1182/blood-2017-07-797423 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/41716
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Title
How I treat heavy menstrual bleeding associated with anticoagulants
Abstract
© 2017 by The American Society of Hematology. 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 levo-norgestrelintrauterinesystem,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.