title: Practice points in gynecardiology: Abnormal uterine bleeding in premenopausal women taking oral anticoagulant or antiplatelet therapy.
abstract: A growing number of premenopausal women are currently using antithrombotic and/or (dual) antiplatelet therapy for various cardiovascular indications. These may induce or exacerbate abnormal uterine bleeding and more awareness and knowledge among prescribers is required. Heavy and irregular menstrual bleeding is common in women in their forties and may have a variety of underlying causes that require different treatment options. Thus using anticoagulants in premenopausal women demands specific expertise and close collaboration between cardiovascular physicians and gynecologists. In this article we summarize the scope of the problem and provide practical recommendations for the care for young women taking anticoagulants and/or (dual) antiplatelet therapy. We also recommend that more safety data on uterine bleeding with novel anticoagulants in premenopausal women should be obtained.
authors.affiliation: Department of Cardiology, Women's Cardiac Health, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Nijmegen 9525GA, The Netherlands. Electronic address: angela.maas@radboudumc.nl.
authors.forename: Angela H E M
authors.initials: AH
authors.lastname: Maas
authors.affiliation: Karolinska Institutet Stroke Research Network, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors.forename: Mia von
authors.initials: Mv
authors.lastname: Euler
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Marlies Y
authors.initials: MY
authors.lastname: Bongers
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Herbert J A
authors.initials: HJ
authors.lastname: Rolden
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Janneke P C
authors.initials: JP
authors.lastname: Grutters
authors.affiliation: Department of Gynecology and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lian
authors.initials: L
authors.lastname: Ulrich
authors.affiliation: Department of Medicine, Cardiac Unit, Centre for Gender Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D002309:Cardiology; D003267:Contraception; D005260:Female; D006176:Gynecology; D006801:Humans; D033183:Interdisciplinary Communication; D008595:Menorrhagia / Q000139:chemically induced* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D017697:Premenopause; D014592:Uterine Hemorrhage / Q000139:chemically induced* / Q000628:therapy
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Abnormal uterine bleeding; Anticoagulants; Antiplatelet therapy; Gynecardiology; Novel oral anticoagulants