<abstract xmlns="http://www.w3.org/1999/xhtml"><p>The symposium focused on issues around surgery, ovulation bleeding, health-related quality of life (HRQoL) and pelvic pain in women with bleeding disorders.</p><sec id="j_jhp00142_s_007_w2aab3b7c29b1b6b1aab1c14b2Aa"><h3>Surgery</h3><p>Young women with congenital bleeding disorders, especially those with severe forms, are more likely to experience gynaecological and obstetric disorders than unaffected women. Surgery may be required to manage heavy menstrual bleeding (HMB), ovulatory bleeding, endometriosis and delivery. Major surgery should be undertaken only in hospitals with a haemophilia centre and 24-hour laboratory capability. Correction of haemostasis, either by desmopressin, coagulation factor or platelet transfusion, is essential for a successful outcome of surgery. Management of pregnancy requires a multidisciplinary approach; the mode of delivery is based on the consensus of gynaecologist and haematologist, and with respect to the patient’s diagnosis.</p></sec><sec id="j_jhp00142_s_008_w2aab3b7c29b1b6b1aab1c14b3Aa"><h3>Ovulation bleeding</h3><p>Women with bleeding disorders are at risk for excessive gynaecological bleeding associated with menstruation, ovulation, pregnancy and delivery. Ovulation bleeding is associated with the rupture of ovarian cysts and causes abdominal pain; complications include haemoperitoneum, fertility problems and ovarian torsion. Management includes hormonal and haemostatic therapies, in combination if necessary, and surgery as a last resort. Current management is based on experience in a relatively small number of cases and more clinical data are needed.</p></sec><sec id="j_jhp00142_s_009_w2aab3b7c29b1b6b1aab1c14b4Aa"><h3>Health-related quality of life</h3><p>In addition to experiencing joint and tissue bleeds, women experience psychosocial and medical issues associated with menstruation, pregnancy, labour and delivery. HMB has the greatest impact, and is associated with impaired HRQoL in almost all and dissatisfaction with the burden of treatment. There is a need for focused psychosocial support and a specific tool for the assessment of HRQoL in women with bleeding disorders.</p></sec><sec id="j_jhp00142_s_010_w2aab3b7c29b1b6b1aab1c14b5Aa"><h3>Pelvic pain</h3><p>Gynaecological causes of pelvic pain in women with bleeding disorders include dysmenorrhoea, mid-cycle pain, bleeding into the corpus luteum and endometriosis. There is no correlation between bleeding tendency and endometriosis severity; however, screening for a bleeding disorder should be considered. Pharmacological management may be hormonal or non-hormonal. Gonadotrophin-releasing hormone agonists offer an alternative to surgery for women with severe bleeding disorders who have endometriosis. Paracetamol is the preferred early analgesic option. Endometrial ablation controls heavy bleeding and pelvic pain but is not recommended for women with large fibroids or a large endometrial cavity. Hysterectomy is an option of last resort. Education for health professionals should include raising awareness about the management of pain in women with bleeding disorders.</p></sec></abstract>

The symposium focused on issues around surgery, ovulation bleeding, health-related quality of life (HRQoL) and pelvic pain in women with bleeding disorders.SurgeryYoung women with congenital bleeding disorders, especially those with severe forms, are more likely to experience gynaecological and obstetric disorders than unaffected women. Surgery may be required to manage heavy menstrual bleeding (HMB), ovulatory bleeding, endometriosis and delivery. Major surgery should be undertaken only in hospitals with a haemophilia centre and 24-hour laboratory capability. Correction of haemostasis, either by desmopressin, coagulation factor or platelet transfusion, is essential for a successful outcome of surgery. Management of pregnancy requires a multidisciplinary approach; the mode of delivery is based on the consensus of gynaecologist and haematologist, and with respect to the patient’s diagnosis.Ovulation bleedingWomen with bleeding disorders are at risk for excessive gynaecological bleeding associated with menstruation, ovulation, pregnancy and delivery. Ovulation bleeding is associated with the rupture of ovarian cysts and causes abdominal pain; complications include haemoperitoneum, fertility problems and ovarian torsion. Management includes hormonal and haemostatic therapies, in combination if necessary, and surgery as a last resort. Current management is based on experience in a relatively small number of cases and more clinical data are needed.Health-related quality of lifeIn addition to experiencing joint and tissue bleeds, women experience psychosocial and medical issues associated with menstruation, pregnancy, labour and delivery. HMB has the greatest impact, and is associated with impaired HRQoL in almost all and dissatisfaction with the burden of treatment. There is a need for focused psychosocial support and a specific tool for the assessment of HRQoL in women with bleeding disorders.Pelvic painGynaecological causes of pelvic pain in women with bleeding disorders include dysmenorrhoea, mid-cycle pain, bleeding into the corpus luteum and endometriosis. There is no correlation between bleeding tendency and endometriosis severity; however, screening for a bleeding disorder should be considered. Pharmacological management may be hormonal or non-hormonal. Gonadotrophin-releasing hormone agonists offer an alternative to surgery for women with severe bleeding disorders who have endometriosis. Paracetamol is the preferred early analgesic option. Endometrial ablation controls heavy bleeding and pelvic pain but is not recommended for women with large fibroids or a large endometrial cavity. Hysterectomy is an option of last resort. Education for health professionals should include raising awareness about the management of pain in women with bleeding disorders.

Gynaecological issues in women with bleeding disorders: CSL Behring Symposium

The Journal of Haemophilia Practice

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

{"article-title":"Gynaecological issues in women with bleeding disorders: CSL Behring Symposium"}

The symposium focused on issues around surgery, ovulation bleeding, health-related quality of life (HRQoL) and pelvic pain in women with bleeding...

	MAJOR SURGERY	MINOR SURGERY
Loading dose VWF:RCo	40–60 IU/kg	30–60 IU/kg
Target level for surgery	VWF: RCo and FVIII 100 IU/dL	VWF: RCo and FVIII ≥80 IU/dL
Maintenance dose VWF:RCo	20–40 IU/kg every 8–24 hours	20–40 IU/kg every 12–24 hours
Sustained post-OP troughs of VWF:RCo and FVIII	>50 IU/dL for 7–14 days	>50 IU/dL for 3–5 days
Monitoring FVIII and VWF:RCo	troughs and peaks daily	trough and peak at least once
Safety parameter	VWF:RCo <200 and FVIII<200-300 IU/dL

Gynaecological issues in women with bleeding disorders: CSL Behring Symposium

Article Category: Women With Bleeding Disorders

Published Online: Oct 21, 2019

Page range: 28 - 38

DOI: https://doi.org/10.17225/jhp00142

Keywords
Women with bleeding disorders, von Willebrand disease, factor VII deficiency, surgery, Slovakia, ovulation bleeding, health-related quality of life, pelvic pain, patient experience

© 2019 Angelika Batorova, Karin van Galen, Sylvia von Mackensen, Ioannis Tsimpanakos, Evelyn Grimberg, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1A

Figure 1B

Figure 2

Women’s personal experiences of surgery

Dosage and monitoring recommendations for patients with VWD undergoing surgery [4,6,7]

Gynaecological issues in women with bleeding disorders: CSL Behring Symposium

Article Category: Women With Bleeding Disorders

Published Online: Oct 21, 2019

Page range: 28 - 38

DOI: https://doi.org/10.17225/jhp00142

KeywordsWomen with bleeding disorders, von Willebrand disease, factor VII deficiency, surgery, Slovakia, ovulation bleeding, health-related quality of life, pelvic pain, patient experience

© 2019 Angelika Batorova, Karin van Galen, Sylvia von Mackensen, Ioannis Tsimpanakos, Evelyn Grimberg, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1A

Figure 1B

Figure 2

Women’s personal experiences of surgery

Dosage and monitoring recommendations for patients with VWD undergoing surgery [4,6,7]

Keywords
Women with bleeding disorders, von Willebrand disease, factor VII deficiency, surgery, Slovakia, ovulation bleeding, health-related quality of life, pelvic pain, patient experience