Bleeding disorders in women

Sep 27, 2017 | Mayo Clinic Hematology Staff | @mayoclinichematologystaff

Dr. Marshall Editorial_1

Did you know as many as 1 in 100 women live with a bleeding disorder? With help from health care providers such as Ariela Marshall, M.D., a Mayo Clinic hematologist and researcher, awareness of the diseases, diagnoses and treatments of bleeding disorders in women are improving.

“It is important to note that not everybody who has a lot of bleeding necessarily has a bleeding disorder,” Dr. Marshall says. “However, with better knowledge and testing, when a patient comes in with bleeding concerns, they go through a whole list of questions regarding their bleeding episodes. It is decided whether or not further investigation is needed.”

Women who are tested could have one of several types of bleeding disorders, but the most common is with a deficiency in a protein called von Willebrand, that helps blood clot. Dr. Marshall explains there are three types of von Willebrand deficiencies:

  • Type 1 von Willebrand
    This is autosomal dominant, meaning you can get it from either parent. Type 1, the most common, is a numbers problem. The body does not have enough von Willebrand proteins present to help with bleeding. Treatment aims to increase the amount of von Willebrand proteins in the body by using desmopressin. Desmopressin, which trigger the body to release its own stores of von Willebrand, are only used during bleeding episodes (i.e., onset of menstruation) and medical procedures.
  • Type 2 von Willebrand
    This has four subtypes: 2A, 2B, 2M and 2N. In each variant of type 2, the von Willebrand protein is present, but the protein does not function properly. To treat this form, a von Willebrand concentrate is used to produce a von Willebrand factor rather than your own. Type 2 also is treated during bleeding episodes or procedures.
  • Type 3 von Willebrand
    This is the most rare type and features a complete absence of the von Willebrand protein. People with this type often experience severe bleeding symptoms starting at an early age. In terms of treatment, this type requires more regular von Willebrand concentrate. Often, a person with type 3 needs von Willebrand concentrate on a regular schedule to bleeding complications.

While von Willebrand is the most common bleeding disorder in women, they can be diagnosed with other disorders more commonly associated with men, such as hemophilia.

“People typically think of hemophilia as something only men get,” Dr. Marshall says. “But women who carry hemophilia can exhibit bleeding symptoms.”

When a woman is a carrier of hemophilia, it means they carry hemophilia on one of their two X chromosomes. Hemophilia commonly is associated with men because a male only receives one X chromosome and has a 50-50 chance of receiving the affected chromosome from his mother.

According to Dr. Marshall, the thinking of what it means to be a carrier of hemophilia has evolved.

“If a woman carries hemophilia, [she] can actually exhibit bleeding symptoms,” Dr. Marshall says. “It has been under recognized, and, now, rather than saying women are carriers of hemophilia, we say that they have a mild hemophilia if they have bleeding symptoms.”

Woman who experience hemophilia-related bleeding symptoms receive the same factor replacement therapy that a male receives.

Bleeding disorders affect women differently than men due to natural differences that women face during stages of their life.

Take a sneak peek at part two's blog on how bleeding disorders affect women differently:

“Not all females with heavy periods suffer from bleeding disorders, but those who do have heavy periods are more likely to have a bleeding disorder than females who do not experience heavy menstrual periods,” Dr. Marshall says.

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Read this related blog post, "Hemophilia: From Mayo Clinic patient, to employee, to Connect moderator."

Autosomal Dominant
Autosomal Dominant

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