Non-gynaecological issues in women with bleeding disorders

Iron deficiency/anaemia and periodontal disease are among the non-gynaecological issues that may present a challenge in women with bleeding disorders. Anaemia is a global health problem, affecting around 32.5% of non-pregnant women aged under 50 and over 40% of pregnant women. It causes fatigue, shortness of breath and dizziness. Anaemia is usually diagnosed by a low serum level of ferritin. Ferritin may be normal in a person who is taking an iron supplement or in the presence of inflammation, in which case the diagnosis can be confirmed by a low transferrin saturation level. A low level of iron should be corrected in a woman with a bleeding disorder, and women must recognise the importance of doing so. If a healthy diet alone does not avoid iron deficiency, oral supplementation is indicated on a low dose regimen to reduce adverse effects; intravenous administration should be used when rapid restoration of iron is indicated. Failure to respond to iron supplementation is an indication for further investigation. Periodontal disease has only recently been recognised as a modern-day epidemic and can have a major impact on quality of life. Oral health has long been ignored in people with a bleeding disorder as bleeding gums secondary to periodontitis are often attributed to the underlying condition. People with a bleeding disorder may therefore feel they can do nothing to improve their oral health. However, healthy gums do not bleed, even in people with a bleeding disorder. While bleeding gums are often accepted as a consequence of having a bleeding disorder, effective cleaning has been shown to reduce gingivitis and bleeding. Regular contact with a dentist should start at a young age and continue throughout life.