Incidence and Impact on Quality of Life of Heavy Menstrual Bleeding in Women on Oral Anticoagulant Therapy

• Published in: Clinical and applied thrombosis/hemostasis Vol. 30; p. 10760296241281366
• Main Authors: Hassan, Naseerah, Schapkaitz, Elise, Rhemtula, Haroun, Ncete, Nolukholo
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2024; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Administration, Oral; Adult; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Cohort analysis; Female; Hemorrhage; Humans; Incidence; Menorrhagia - drug therapy; Menstruation; Middle Aged; Original; Prospective Studies; Quality of Life; Risk Factors; Rivaroxaban - administration & dosage; Rivaroxaban - adverse effects; Rivaroxaban - therapeutic use; South Africa; Warfarin - adverse effects; Warfarin - therapeutic use; Women; South Africa; pictorial blood loss assessment chart; menstrual bleeding questionnaire; rivaroxaban; iron deficiency; heavy menstrual bleeding; warfarin
• ISSN: 1076-0296; 1938-2723; 1938-2723
• DOI: 10.1177/10760296241281366

Introduction Heavy menstrual bleeding affects up to two thirds of women on oral anticoagulation. The rates of heavy menstrual bleeding, its impact on quality of life and associated risk factors in women attending anticoagulation clinics in South Africa are largely unknown. Materials and Methods A prospective cohort study was performed over an eight-month period in women on Warfarin (n = 30) and Rivaroxaban (n = 27) for a median [interquartile range] duration of 15.5 [78.0] months attending an anticoagulation clinic in Johannesburg, South Africa. Heavy menstrual bleeding was assessed over one menstrual cycle using the validated pictorial blood loss assessment charts (PBAC) and the menstrual bleeding questionnaire (MBQ). Results In this population of predominantly African ethnicity, with a median age of 39 [8] years, 39 (68.4%) women experienced heavy menstrual bleeding, defined as a PBAC score of >100. Median cycle length on anticoagulation and MBQ scores were significantly higher among women with a PBAC score of >100 (p > 0.05). Univariate analysis identified Rivaroxaban as a risk factor for heavy menstrual bleeding (OR 5.03, 95% CI 1.40–18.12). Heavy menstrual bleeding required treatment in 29 (74.4%) women which included management of iron deficiency, anti-fibrinolytics, modification of anticoagulation and hormonal contraception. Conclusion Heavy menstrual bleeding was associated with a considerable negative impact on quality of life. This was most significant for women on Rivaroxaban as compared to Warfarin. It is essential to monitor and appropriately treat heavy menstrual bleeding in at risk women on anticoagulant treatment.