(HealthDay News) – Bleeding disorders play an important role in both explained and unexplained cases of heavy menstrual bleeding (HMB) due in many cases to low but not deficient factor XI levels, according to research published in the September issue of the American Journal of Obstetrics & Gynecology.

H. Marieke Knol, MD, PhD, of the University Medical Centre Groningen in the Netherlands, and colleagues conducted a single-center prospective cohort study involving 112 consecutive patients who were treated for heavy menstrual bleeding with and without gynecologic abnormalities and 28 healthy volunteers.

The researchers found that, overall, 46% of women with HMB had anemia compared with 7% of control subjects. In those with HMB, 26% had gynecologic abnormalities (considered to explain HMB) and 29% had an underlying bleeding disorder (31% with unexplained HMB and 27% with explained HMB; P=0.75). Bleeding disorders identified in women with HMB included von Willebrand’s disease, factor XI deficiency, and factor VII deficiency. Compared with control subjects, women with HMB had significantly longer activated partial thromboplastin times caused by lower, but not deficient, factor XI levels.

“In conclusion, HMB is a multifactorial problem with concurrent gynecologic abnormalities and bleeding disorders,” the authors write. “Underlying bleeding disorders play an important role in the cause of HMB with and without gynecologic abnormalities.”

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