Having difficulty with success recommending the levonorgestrel-releasing IUD. Several women with VWD have had them removed shortly after placement because of a dramatic increase in bleeding for several weeks after the procedure. Any suggestions? These were women without success using various birth control pills (BCPs). Parenteral hormonal therapy in preparation? Aminocaproic acid?  

Richard Lipton, MD, Physician-In-Charge, Hemophilia Treatment Center
Long Island Jewish Medical Center, New Hyde Park, NY

I would like to think that women could be encouraged to persevere during the first few weeks/months with the levonorgestrel-releasing IUD when a pre-existing thickened endometrium may be shedding.  If women/girls continue to have irregular bleeding with a levonorgestrel-releasing IUD, we can cycle them with low-dose estrogen or a low-dose birth control pill (BCP), such as norethindrone/ethinyl estradiol, with only three days off of hormone. 

Before starting aminocaproic acid, we would suggest starting the new oral tranexamic preparation, which we believe is better tolerated than aminocaproic acid. This can be used with levonorgestrel-releasing IUD in place or in lieu of levonorgestrel-releasing IUD.

I hope this helps.

Andra James, MD, MPH
Director/Founder of the Women's Hemostasis and Thrombosis Clinic
Duke University Medical Center
Associate Professor of Obstetrics & Gynecology
Duke University School of Medicine
Durham, NC