title: The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities.
abstract: OBJECTIVE
  The purpose of this study was to assess the prevalence of underlying bleeding disorders in women with heavy menstrual bleeding (HMB) with and without gynecologic abnormalities.
  
  
  METHODS
  We performed a single-center prospective cohort study of 112 consecutive patients who were referred for heavy menstrual bleeding. Control subjects were 28 healthy volunteers who reported no HMB. Patients and control subjects had hemostatic testing in the first week after menstruation. Patients underwent gynecologic evaluation.
  
  
  RESULTS
  The median age was 42.5 years (range, 17-55 years) in patients and 40.0 years (range, 25-55 years) in control subjects. Forty-six percent of patients had anemia; the median pictorial bleeding assessment chart score was 271. Seven percent of the control subjects with a subjectively normal menstruation had anemia. Twenty-six percent of patients had gynecologic abnormalities, which was considered to explain HMB. Overall, we found an underlying bleeding disorder in 29% of the patients, which was comparable for unexplained and explained HMB (31% vs 27%; P = .75). We diagnosed 6 cases of Von Willebrand's disease, 4 cases of factor XI deficiency, and 1 case of factor VII deficiency. The only abnormalities that we found in control subjects were platelet aggregation defects (11% in control subjects vs 23% in patients). Patients had a significantly longer activated partial thromboplastin time compared with control subjects (26.5 vs 25.0 seconds; P = .001) that was caused by lower median levels of factor XI (100 vs 124 IU/dL; P < .001).
  
  
  CONCLUSIONS
  Bleeding disorders play an equally important role in the cause of both unexplained and explained heavy menstrual bleeding. A novel finding is the occurrence of low, but not deficient, levels of factor XI.
authors.affiliation: Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Centre Groningen, Groningen, The Netherlands. h.m.knol@umcg.nl
authors.forename: H Marieke
authors.initials: HM
authors.lastname: Knol
authors.forename: André B
authors.initials: AB
authors.lastname: Mulder
authors.forename: Dick H
authors.initials: DH
authors.lastname: Bogchelman
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
authors.forename: Karina
authors.initials: K
authors.lastname: Meijer
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005172:Factor XI / Q000032:analysis; D005260:Female; D006474:Hemorrhagic Disorders / Q000150:complications* / Q000453:epidemiology; D006487:Hemostasis; D006801:Humans; D008595:Menorrhagia / Q000209:etiology*; D008875:Middle Aged; D010974:Platelet Aggregation; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D005172:Factor XI
keywords: bleeding disorder; factor XI; heavy menstrual bleeding; menorrhagia; von Willebrand's disease