The Curbsiders Internal Medicine Podcast

#280 Heavy Menstrual Bleeding, Anticoagulation & Coagulopathy in Menstruating Patients

Jun 21, 2021
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INSIGHT

What Actually Defines Heavy Periods

  • Normal menstrual blood loss averages ~53 mL per cycle but clinically meaningful heavy bleeding correlates with >80 mL and functional impact.
  • Ask about frequency of changing protection, clot size, duration, and interference with life to detect heavy bleeding.
ADVICE

Key Questions To Screen For Heavy Bleeding

  • Ask direct, high-yield questions: how often do you change pads/tampons on heaviest days and do you have iron deficiency.
  • Also ask if they wear pad and tampon together and whether bleeding affects quality of life.
INSIGHT

Bleeding Disorders Behind Heavy Periods

  • About 20% of women with heavy menstrual bleeding have an underlying bleeding disorder, most commonly von Willebrand disease.
  • Many bleeding disorders present as mucocutaneous bleeding rather than joint bleeds typical of hemophilia.
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