Von Willebrand Disease and Women
Von Willebrand disease (VWD) is the most common type of bleeding disorder, affecting both men and women. While men and women with VWD may experience some of the same symptoms, women tend to experience more symptoms than men throughout their lives due to their menstrual cycle and childbirth.
One of the most common symptoms for women with VWD is heavy, prolonged menstrual bleeding. Some women experience heavy bleeding throughout their normal menstrual period, which is called menorrhagia. Other women may bleed unpredictably throughout the month, which is known as metrorrhagia.
Some signs of heavy menstrual bleeding include:
- Bleeding for longer than 7 days
- Changing a tampon or pad every 2 hours or less on the heaviest day
- Flooding or gushing blood that limits daily activities
- Passing blood clots larger than a quarter
Heavy menstrual bleeding could even lead to anemia. Signs of anemia to watch for include weakness, tiredness, and paleness. If a woman notices any of these symptoms, she should contact her doctor.
For women with VWD who experience menorrhagia, oral contraceptives may help reduce menstrual bleeding. Additionally, a birth control pill may raise the level of von Willebrand factor (VWF) in the blood of women with Type 1 VWD. While oral contraceptives may not improve VWF levels for women with Type 2 or Type 3 VWD, they may be helpful in regulating periods and reducing blood flow.
Some women don’t notice symptoms of a bleeding disorder until they enter puberty and start getting their menstrual periods. Menstrual bleeding can be especially heavy when a girl first starts having periods. If there is a family history of VWD or other bleeding disorders, or it’s already known that a girl has the disorder, it’s recommended that she be closely followed by a medical team during puberty, including a family doctor or pediatrician, a gynecologist with experience treating bleeding disorders, and healthcare professionals at a hemophilia treatment center. It may also be helpful to inform her of what is considered “normal” menstrual bleeding, which includes:
- The number of days menstrual cycles typically last
- The number of pads and tampons typically used
- The amount of blood flow to expect
- The time and amount of menstrual bleeding for a girl with VWD or another bleeding disorder
Having von Willebrand disease does not typically affect a woman’s ability to get pregnant. In fact, women with VWD may actually experience fewer bleeding problems during pregnancy. The high hormone levels associated with pregnancy stimulate the production of blood-clotting proteins, causing levels of VWF and factor VIII to rise closer to normal in women with Type 1 VWD.
Women with VWD, however, can have heavy bleeding for an extended period of time after delivery when VWF levels return to their normal levels. In fact, postpartum bleeding is more common in women with VWD than in the general population, which may mean a woman would need to be more closely monitored for bleeding in the hours, days, and weeks after delivering. However, breastfeeding can help keep VWF levels raised after childbirth in women with Type 1 VWD.
If a woman with VWD feels her postpartum bleeding is excessive, she should immediately let her obstetrician or hematologist know.