(PWBD-WE-02.3) Heavy menstrual bleeding (HMB) and impact on QoL: How to manage

Heavy menstrual bleeding (HMB) is the most frequent bleeding symptom in women and girls with inherited bleeding disorders (WGBD). Due to its monthly recurrent nature, HMB has the worst impact on women’s health and quality of life compared to other bleeding symptoms. In a large European survey, over a half of WGBD self-reported presence of HMB; a most likely bleeding symptom to adversely impact day-to- day living. It is well established that HMB results in decreased QoL, time lost from school/work, missed employment opportunities, impaired social and sport activities with negative feelings for most of women. HMB is the leading cause of iron deficiency (ID) and anaemia (IDA) in women with a further negative health and QoL impact. Factors associated with poorer QoL in WGBD with HMB include longer duration of menstruation, higher menstrual score, passage of lots and flooding and presence of pain. WGBD are more likely to require surgical interventions to manage HMB including hysterectomy at a younger age compared to women without bleeding disorders. HMB in WGBD could be due to their coagulation defect and/or common gynaecological conditions such as fibroids, adenomyosis, endometriosis and polyps. For these reasons, WGBD require and multidisciplinary care including a close collaboration and communication between gynaecology and haematology teams. It is essential that management plan is tailored to women’s individual needs and expectations. WGBD often require a combination of haemostatic and hormonal therapies for control of HMB. Increased awareness and education of health care professionals of the treatment options and counselling of benefits and possible adverse effects of these treatment are important to improve compliance and response to treatment.