This protocol addresses a female patient with Von Willebrand disease who presents with heavy menstrual bleeding and does not wish to conceive. The clinical management in this setting takes into account both the bleeding disorder and the patient's reproductive intentions.

Clinical Scenario

Female patient with Von Willebrand disease and heavy menstrual bleeding, not planning pregnancy. The co-occurrence of a systemic bleeding disorder with significant menstrual blood loss defines the therapeutic approach in this population.

First-Line Approach — Partial Overview

Hormonal therapy and tranexamic acid represent the recognised first-line directions in this setting. When initial control of heavy menstrual bleeding is less than optimal, these options may be used in combination — the full selection criteria and regimen details are in the complete protocol.

References

DOI: 10.1182/bloodadvances.2020003264.

The panel suggests using either hormonal therapy (CHC or levonorgestrel-releasing intrauterine system) or tranexamic acid over desmopressin to treat women with VWD with heavy menstrual bleeding who do not wish to conceive (conditional recommendation based on very low certainty in the evidence of effects).
This recommendation does not imply that the interventions considered can be prescribed only as monotherapy. In some cases, multiple options can be combined, especially if control of heavy menstrual bleeding is less than optimal with the initial therapy.

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Treatment of Von Willebrand Disease with Heavy Menstrual Bleeding in Women Not Wishing to Conceive

References