title: von Willebrand's disease diagnosed after menorrhagia worsened from levonorgestrel intrauterine system.
abstract: BACKGROUND
  Adult females with menorrhagia may have unrecognized mild von Willebrand's disease. Most females with known von Willebrand's disease report menorrhagia.
  
  
  METHODS
  A 38-year-old healthy female desired contraception. She described heavy menses lasting 8 days since menarche. History included uncomplicated vaginal deliveries. Physical examination was normal. The levonorgestrel intrauterine system was placed. Her menorrhagia then worsened to 14 successive days each month. Evaluation revealed mild von Willebrand's disease. At 19 months of follow-up, she retained her levonorgestrel intrauterine system and avoided pregnancy. Her menses slowly improved to spotting for 8 days each month.
  
  
  CONCLUSIONS
  Von Willebrand's disease is a likely cause of menorrhagia that goes unrecognized as well as a potential cause for "failed" conservative treatment for menorrhagia. Understanding the cause of menorrhagia is an important aspect of evaluating this common symptom.
authors.affiliation: Department of Obstetrics and Gynecology and Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. lukes001@mc.duke.edu
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Lukes
authors.forename: Stephanie
authors.initials: S
authors.lastname: Perry
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
mesh_terms: D000328:Adult; D003267:Contraception / Q000009:adverse effects / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000009:adverse effects* / Q000627:therapeutic use; D008595:Menorrhagia / Q000175:diagnosis* / Q000209:etiology; D018570:Risk Assessment; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000175:diagnosis* / Q000628:therapy
chemical_list: D016912:Levonorgestrel