Hemorrhage and Thrombosis in Women

Abstract

Menstrual bleeding, pregnancy, and estrogen-containing therapies all provide unique challenges to the hemostatic system in women. Heavy menstrual bleeding is a common presenting symptom for women with inherited bleeding disorders such as von Willebrand disease and is also a relatively common complication of anticoagulation therapy in reproductive-aged women. Female carriers of mutations of factors VIII or IX, associated with hemophilia in men, can have varied presentations also sometimes characterized by excessive menstrual or other bleeding. High estrogen states, such as pregnancy and combined oral contraceptive use, are associated with an increased risk of thrombosis. Venous thromboembolism (VTE) occurring in such settings is associated with a remarkably low risk of recurrence but patients with a history of these and other types of VTE require special consideration with regard to future hormonal therapies, including contraceptives and hormone replacement therapy. Here we summarize the diagnosis and management of hemorrhagic and thrombotic risks and outcomes specific to nonpregnant female patients.