Menorrhagia and minor bleeding symptoms in women on oral anticoagulation.
BACKGROUND
Oral anticoagulation (OA) is a common treatment with a known risk of fatal or major bleeding, but also minor bleeding symptoms and menorrhagia can cause substantial discomfort and necessitate medical or surgical interventions. The extent of these side effects is however not previously reported. The objective of this study is to assess the frequency of minor bleeding symptoms and menorrhagia attributed to OA treatment.


METHODS
Ninety fertile women between 15 and 49 years-of-age on OA treatment completed an inquiry at the anticoagulation clinics of Malmö, Lund and Gothenburg, Sweden.


RESULTS
The frequency of minor bleeding symptoms was significantly increased during OA treatment (P < 0.05) except for hematuria. The incidence of bleeding after tooth extraction (>3 h) increased from 3.0 to 45.2%, easy bruising 17.8-75.6%, epistaxis 11.1-23.6%, gingival bleeding 22.2-48.3% and hematuria 10.0-15.6% (Table 1). Hematemesis was reported in 5.6% prior to as compared to 14.4% during OA treatment, blood in the feces in 8.9 and 18.9%, respectively. Mean duration of menses increased from 5.6 to 6.1 days (P < 0.01) and reported menorrhagia from 44.2 to 70.8% (P < 0.001). Eighteen percent were treated for menorrhagia before and 29.9% during OA treatment (P < 0.01).


CONCLUSIONS
OA treatment is known to confer increased risk of fatal or major bleeding. This study shows that fertile women on OA also experience significantly increased minor bleeding symptoms including menorrhagia that may considerably impair quality of life.
Själander
Anders
A
Department of Internal Medicine, Sundsvall Hospital, Sundsvall, Sweden.
Friberg
Britt
B
Svensson
Peter
P
Stigendal
Lennart
L
Lethagen
Stefan
S
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D004844:Epistaxis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005882:Gingival Diseases / Q000453:epidemiology / Q000209:etiology; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008595:Menorrhagia / Q000453:epidemiology / Q000209:etiology*; D008598:Menstruation / Q000502:physiology; D008875:Middle Aged; D013997:Time Factors; D014081:Tooth Extraction / Q000009:adverse effects
D000925:Anticoagulants