Blood Disorders

Why Focus on Blood Disorders in Women and Girls+?
While blood disorders affect both men and women, there are serious added consequences for women and girls+ due to the gynecologic challenges encountered during the menstrual cycle and throughout the reproductive life stages such as pregnancy, childbirth, and menopause. 

Life stageUnique Issues for Women and Girls with Blood Disorders
AdolescenceAnticipation of menses

If bleeding disorder, anticoagulation or thrombocytopenia:
– menorrhagia/heavy menstrual bleeding (HMB)
– hemorrhagic ovarian cysts
– possibly endometriosis

Risks and benefits of hormonal contraception
Pre-conceptionGenetic counseling for inherited bleeding disorders
Risks to the mother of a pregnancy
Risks to the unborn baby associated with pregnancy 
Pregnancy↓ risk of bleeding
↑ risk of thrombosis
↓ platelet count
↓ hemoglobin
↑ frequency of sickle cell crises

Exacerbation of endothelial dysfunction with preeclampsia
ChildbirthRisks of regional anesthesia for women with bleeding disorders, thrombocytopenia, or on anticoagulation
PostpartumRisks of delayed hemorrhage in women with bleeding disorders
Risks of thrombosis
PerimenopauseManagement of bleeding due to fibroids, polyps, and endometrial hyperplasia
Risks and benefits of hormone replacement
Prophylaxis for either bleeding or clotting around procedures
Source: With permission from Dr. Andra James. Chart from PowerPoint slides, Introduction to FWGBD, May 2010.

The treatment and management of blood disorders present unique issues for women and girls. The delay in and/or failure to diagnose and treat blood disorders in women and girls are major public health problems. These result in significant morbidity, reduced quality of life, days lost from work and school, unnecessary invasive procedures, and high healthcare costs.