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Evaluation of Von Willebrand Disease in Women with Menorrhagia: Insights from a Cohort Study

Year 2025, Volume: 12 Issue: 2, 179 - 183, 28.08.2025
https://doi.org/10.47572/muskutd.1571628

Abstract

This study aimed to evaluate the prevalence of von Willebrand disease (VWD) among women presenting with menorrhagia and to assess the diagnostic utility of the VWD simple screening tool. A prospective cohort study was conducted involving 70 women, aged 18–48 years, who presented to gynecology clinics with complaints of menorrhagia. Patients were administered an 8-question screening tool, routine tests and underwent further testing for von Willebrand factor antigen (VWF:Ag) and ristocetin cofactor activity (VWF:RCo). Hematologic and coagulation parameters, including hemoglobin, ferritin, activated partial thromboplastin time and prothrombin time were compared between the groups. Of the 70 patients, 22 (31%) were prediagnosed with VWD based on low VWF:Ag and VWF:RCo levels. The VWD group had a higher body mass index (31.19±3.74 vs. 28.20±5.36 kg/m², p<0.05), higher parity (4 vs. 3, p<0.05), and slightly elevated activated partial thromboplastin time levels (26.9 vs. 25.5 seconds, p<0.05) compared to the control group. Hemoglobin, ferritin, and other hematologic parameters were similar between the groups. Using the method applied in this study, 31% of patients with menorrhagia were suspected to have von Willebrand disease, a higher prevalence than reported in other studies. While the VWD simple screening tool was effective in identifying patients with menorrhagia, it fell short in accurately distinguishing those with VWD. Larger prospective studies are needed to enhance the diagnosis of VWD in menorrhagia patients and to better determine its true prevalence.

References

  • Wyatt KM, Dimmock PW, Walker TJ, et al. Determination of total menstrual blood loss. Fertil Steril. 2001;76:1:p. 125-31.
  • Crombie DL ,Fleming DM. The third national study of morbidity statistics from general practice. J R Coll Gen Pract. 1986; 36:283:p.51-2.
  • Acog. Committee Opinion No.580: von Willebrand disease in women. Obstet Gynecol. 2013;122:6:p.1368-73.
  • James AH. Von Willebrand disease. Obstet Gynecol Surv. 2006; 61:2: p. 136-45.
  • Shankar M, Lee CA, Sabin CA, et al. von Willebrand disease in women with menorrhagia: a systematic review. BJOG. 2004;111:7:p.734-40.
  • Lukes AS, Kadir RA, Peyvandi F, et al. Disorders of hemostasis and excessive menstrual bleeding: prevalence and clinical impact. Fertil Steril. 2005;84:5:p.1338-44.
  • Kujovich JL. von Willebrand's disease and menorrhagia: prevalence, diagnosis, and management. Am J Hematol. 2005;79:3:p.220-8.
  • Seidizadeh O, Eikenboom JCJ, Denis CV, et al. von Willebrand disease. Nat Rev Dis Primers. 2024;10:1:p.51.
  • Kadir RA, Economides DL, Sabin CA, et al. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998;351:9101:p.485-9.
  • Edlund M, Blomback M, Von Schoultz B, et al. On the value of menorrhagia as a predictor for coagulation disorders. Am J Hematol. 1996;53:4:p.234-8.
  • Philipp CS, Faiz A, Dowling NF, et al. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol. 2008;198:2:p. 163e1-8.
  • Philipp CS, Faiz A, Heit JA, et al. Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia. Am J Obstet Gynecol. 2011;204:3:p.209 e1-7.
  • Bowman M, Hopman WM, Rapson D, et al. The prevalence of symptomatic von Willebrand disease in primary care practice. J Thromb Haemost. 2010;8:1:p.213-6.
  • Woo YL, White B, Corbally R, et al. von Willebrand's disease: an important cause of dysfunctional uterine bleeding. Blood Coagul Fibrinolysis. 2002;13:2:p.89-93.
  • Hayward CP, Moffat KA ,Graf L. Technological advances in diagnostic testing for von Willebrand disease: new approaches and challenges. Int J Lab Hematol. 2014;36:3:p.334-40.
  • Bellissimo DB, Christopherson PA, Flood VH, et al. VWF mutations and new sequence variations identified in healthy controls are more frequent in the African-American population. Blood. 2012;119:9: p.2135-40.
  • Seidizadeh O, Cairo A, Baronciani L, et al. Population-based prevalence and mutational landscape of von Willebrand disease using large-scale genetic databases. NPJ Genom Med. 2023;8:1:p.31.
  • James A, Matchar DB, Myers ER. Testing for von Willebrand disease in women with menorrhagia: a systematic review. Obstet Gynecol. 2004;104:2:p.381-8.
  • Ragni MV, Machin N, Malec LM, et al. Von Willebrand factor for menorrhagia: a survey and literature review. Haemophilia. 2016;22:3:p.397-402.
  • Hayward CPM. How I investigate for bleeding disorders. Int J Lab Hematol. 2018;40 Suppl 1:p.6-14.
  • Schrager S, Yogendran L, Marquez CM, et al. Adenomyosis: Diagnosis and Management. Am Fam Physician. 2022;105:1:p.33-8.
  • Zia A, Stanek J, Christian-Rancy M, et al. Utility of a screening tool for haemostatic defects in a multicentre cohort of adolescents with heavy menstrual bleeding. Haemophilia. 2018;24:6:p.957-63.
  • Keskin HL, Engin Ustun Y, Sanisoglu S, et al. The value of autopsy to determine the cause of maternal deaths in Turkey. J Turk Ger Gynecol Assoc. 2018;19:4: p.210-4.
  • Çallıoğlu N, 3. Trimester Kanamalar, in Ç. Helvacıoğlu, Editor.Kadın hastalıkları ve Doğumda Güncel Konular. Lyon: Livre de Lyon, p.123-145, 2021.
  • Kouides PA. Current understanding of von Willebrand's disease in women - some answers, more questions. Haemophilia. 2006;12(3):p.143-51.
  • Cote I, Jacobs P ,Cumming D. Work loss associated with increased menstrual loss in the United States. Obstet Gynecol. 2002;100:4:p.683-7.

Menorajisi Olan Kadınlarda Von Willebrand Hastalığının Değerlendirilmesi: Bir Kohort Çalışmasının Sonuçları

Year 2025, Volume: 12 Issue: 2, 179 - 183, 28.08.2025
https://doi.org/10.47572/muskutd.1571628

Abstract

Çalışmanın amacı, menoraji şikayetiyle gelen kadınlarda von Willebrand hastalığının (VWD) yaygınlığını değerlendirmek, VWD basit tarama ölçeğinin tanısal faydasını değerlendirmektir.
Çalışma, menoraji şikayeti ile jinekoloji polikliniklerine başvuran 18-48 yaş aralığındaki kadınlarda yürütülen prospektif kohort araştırmadır. Çalışmaya 70 hasta dahil edilmiş olup hastalara 8 soruluk bir VWD basit tarama ölçeği, rutin testler ve von Willebrand faktör antijeni (VWF:Ag) ve ristocetin kofaktör aktivitesi (VWF:RCo) testleri uygulanmıştır. Hemoglobin, ferritin, aktive parsiyel tromboplastin zamanı ve protrombin zamanı dahil olmak üzere hematolojik ve pıhtılaşma parametreleri değerlendirildi. Dahil edilen 70 hastanın 22'sinde (%31) azalmış VWF:Ag ve VWF:RCo seviyelerine dayanarak VWD öntanısı konuldu. VWD grubunun kontrol grubuna kıyasla daha yüksek vücut kitle indeksi (31.19±3.74 ve 28.20±5.36 kg/m², p<0.05), daha yüksek doğum sayısı (4'e karşı 3, p<0,05) ve hafif yüksek aktive parsiyel tromboplastin zamanı seviyeleri (26.9 ve 25.5 saniye, p<0.05) saptandı. Hemoglobin, ferritin ve diğer hematolojik parametreler gruplar arasında benzerdi. Çalışmada kullanılan yöntem ile VWD şüphesi, menorajisi olan hastaların %31'inde tespit edildi, bu diğer çalışmalardan elde edilen bulgulara kıyasla daha yüksek bir değerdir. VWD basit tarama ölçeği menorojili hastaların seçiminde faydalı ancak VWD ayrımını yapmada yetersiz kalmıştır. Menorajisi olan hastalarda VWD tanısının iyileştirilmesi ve gerçek yaygınlığının saptanması için daha büyük ölçekli prospektif araştırmalar gereklidir.

References

  • Wyatt KM, Dimmock PW, Walker TJ, et al. Determination of total menstrual blood loss. Fertil Steril. 2001;76:1:p. 125-31.
  • Crombie DL ,Fleming DM. The third national study of morbidity statistics from general practice. J R Coll Gen Pract. 1986; 36:283:p.51-2.
  • Acog. Committee Opinion No.580: von Willebrand disease in women. Obstet Gynecol. 2013;122:6:p.1368-73.
  • James AH. Von Willebrand disease. Obstet Gynecol Surv. 2006; 61:2: p. 136-45.
  • Shankar M, Lee CA, Sabin CA, et al. von Willebrand disease in women with menorrhagia: a systematic review. BJOG. 2004;111:7:p.734-40.
  • Lukes AS, Kadir RA, Peyvandi F, et al. Disorders of hemostasis and excessive menstrual bleeding: prevalence and clinical impact. Fertil Steril. 2005;84:5:p.1338-44.
  • Kujovich JL. von Willebrand's disease and menorrhagia: prevalence, diagnosis, and management. Am J Hematol. 2005;79:3:p.220-8.
  • Seidizadeh O, Eikenboom JCJ, Denis CV, et al. von Willebrand disease. Nat Rev Dis Primers. 2024;10:1:p.51.
  • Kadir RA, Economides DL, Sabin CA, et al. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998;351:9101:p.485-9.
  • Edlund M, Blomback M, Von Schoultz B, et al. On the value of menorrhagia as a predictor for coagulation disorders. Am J Hematol. 1996;53:4:p.234-8.
  • Philipp CS, Faiz A, Dowling NF, et al. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol. 2008;198:2:p. 163e1-8.
  • Philipp CS, Faiz A, Heit JA, et al. Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia. Am J Obstet Gynecol. 2011;204:3:p.209 e1-7.
  • Bowman M, Hopman WM, Rapson D, et al. The prevalence of symptomatic von Willebrand disease in primary care practice. J Thromb Haemost. 2010;8:1:p.213-6.
  • Woo YL, White B, Corbally R, et al. von Willebrand's disease: an important cause of dysfunctional uterine bleeding. Blood Coagul Fibrinolysis. 2002;13:2:p.89-93.
  • Hayward CP, Moffat KA ,Graf L. Technological advances in diagnostic testing for von Willebrand disease: new approaches and challenges. Int J Lab Hematol. 2014;36:3:p.334-40.
  • Bellissimo DB, Christopherson PA, Flood VH, et al. VWF mutations and new sequence variations identified in healthy controls are more frequent in the African-American population. Blood. 2012;119:9: p.2135-40.
  • Seidizadeh O, Cairo A, Baronciani L, et al. Population-based prevalence and mutational landscape of von Willebrand disease using large-scale genetic databases. NPJ Genom Med. 2023;8:1:p.31.
  • James A, Matchar DB, Myers ER. Testing for von Willebrand disease in women with menorrhagia: a systematic review. Obstet Gynecol. 2004;104:2:p.381-8.
  • Ragni MV, Machin N, Malec LM, et al. Von Willebrand factor for menorrhagia: a survey and literature review. Haemophilia. 2016;22:3:p.397-402.
  • Hayward CPM. How I investigate for bleeding disorders. Int J Lab Hematol. 2018;40 Suppl 1:p.6-14.
  • Schrager S, Yogendran L, Marquez CM, et al. Adenomyosis: Diagnosis and Management. Am Fam Physician. 2022;105:1:p.33-8.
  • Zia A, Stanek J, Christian-Rancy M, et al. Utility of a screening tool for haemostatic defects in a multicentre cohort of adolescents with heavy menstrual bleeding. Haemophilia. 2018;24:6:p.957-63.
  • Keskin HL, Engin Ustun Y, Sanisoglu S, et al. The value of autopsy to determine the cause of maternal deaths in Turkey. J Turk Ger Gynecol Assoc. 2018;19:4: p.210-4.
  • Çallıoğlu N, 3. Trimester Kanamalar, in Ç. Helvacıoğlu, Editor.Kadın hastalıkları ve Doğumda Güncel Konular. Lyon: Livre de Lyon, p.123-145, 2021.
  • Kouides PA. Current understanding of von Willebrand's disease in women - some answers, more questions. Haemophilia. 2006;12(3):p.143-51.
  • Cote I, Jacobs P ,Cumming D. Work loss associated with increased menstrual loss in the United States. Obstet Gynecol. 2002;100:4:p.683-7.
There are 26 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases, Clinical Sciences (Other)
Journal Section Original Article
Authors

Sebile Güler Çekiç 0000-0002-1632-1170

Merve Aldıkaçtıoğlu Talmaç 0000-0001-7219-1772

İbrahim Polat 0000-0002-1418-634X

Publication Date August 28, 2025
Submission Date October 22, 2024
Acceptance Date August 1, 2025
Published in Issue Year 2025 Volume: 12 Issue: 2

Cite

APA Güler Çekiç, S., Aldıkaçtıoğlu Talmaç, M., & Polat, İ. (2025). Evaluation of Von Willebrand Disease in Women with Menorrhagia: Insights from a Cohort Study. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 12(2), 179-183. https://doi.org/10.47572/muskutd.1571628
AMA Güler Çekiç S, Aldıkaçtıoğlu Talmaç M, Polat İ. Evaluation of Von Willebrand Disease in Women with Menorrhagia: Insights from a Cohort Study. MMJ. August 2025;12(2):179-183. doi:10.47572/muskutd.1571628
Chicago Güler Çekiç, Sebile, Merve Aldıkaçtıoğlu Talmaç, and İbrahim Polat. “Evaluation of Von Willebrand Disease in Women With Menorrhagia: Insights from a Cohort Study”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12, no. 2 (August 2025): 179-83. https://doi.org/10.47572/muskutd.1571628.
EndNote Güler Çekiç S, Aldıkaçtıoğlu Talmaç M, Polat İ (August 1, 2025) Evaluation of Von Willebrand Disease in Women with Menorrhagia: Insights from a Cohort Study. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12 2 179–183.
IEEE S. Güler Çekiç, M. Aldıkaçtıoğlu Talmaç, and İ. Polat, “Evaluation of Von Willebrand Disease in Women with Menorrhagia: Insights from a Cohort Study”, MMJ, vol. 12, no. 2, pp. 179–183, 2025, doi: 10.47572/muskutd.1571628.
ISNAD Güler Çekiç, Sebile et al. “Evaluation of Von Willebrand Disease in Women With Menorrhagia: Insights from a Cohort Study”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12/2 (August2025), 179-183. https://doi.org/10.47572/muskutd.1571628.
JAMA Güler Çekiç S, Aldıkaçtıoğlu Talmaç M, Polat İ. Evaluation of Von Willebrand Disease in Women with Menorrhagia: Insights from a Cohort Study. MMJ. 2025;12:179–183.
MLA Güler Çekiç, Sebile et al. “Evaluation of Von Willebrand Disease in Women With Menorrhagia: Insights from a Cohort Study”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, vol. 12, no. 2, 2025, pp. 179-83, doi:10.47572/muskutd.1571628.
Vancouver Güler Çekiç S, Aldıkaçtıoğlu Talmaç M, Polat İ. Evaluation of Von Willebrand Disease in Women with Menorrhagia: Insights from a Cohort Study. MMJ. 2025;12(2):179-83.