NEW YORK (Reuters Health) – The vast majority of young girls in the U.S. with heavy menstrual bleeding are not screened for von Willebrand disease, despite longstanding recommendations from the American College of Obstetricians and Gynecologists (ACOG), a new study indicates.
Up to 20% of girls with heavy menstrual bleeding will have an underlying bleeding disorder, most commonly von Willebrand disease, note Dr. Amanda Jacobson of Nationwide Children’s Hospital and The Ohio State University in Columbus, Ohio, and colleagues in Obstetrics & Gynecology, online May 7.
“Onset of heavy menstrual bleeding at menarche is often the first sign of von Willebrand disease in affected patients. Early diagnosis of von Willebrand disease allows for additional treatment strategies for heavy menses if needed and prophylaxis for bleeding during future surgical procedures or childbirth,” they point out.
Yet their analysis, of 2011-2013 national claims data for more than 23,800 postpubertal girls and adolescents (age 10 to 17) with a diagnosis of heavy menstrual bleeding, shows only 8% were screened for a deficiency of von Willebrand factor. Screening rates were somewhat better (16%) among those with severe heavy menstrual bleeding.
Factors associated with a higher frequency of von Willebrand disease screening were younger age at diagnosis, inpatient stay for heavy menstrual bleeding, diagnosis of and testing for iron deficiency anemia, having commercial insurance, having an obstetrician-gynecologist at the initial encounter for heavy menstrual bleeding, and living in a metropolitan area.
“Increased awareness and adherence to recommended screening recommendations may increase diagnosis of von Willebrand disease,” the authors conclude.
They note that a variety of health care providers will be “first responders” for girls and adolescents with heavy menstrual bleeding, “which emphasizes the need for increased awareness of von Willebrand disease among all health care providers taking care of adolescent females and recognition that heavy menstrual bleeding is the most common and often the first bleeding symptom in young women with von Willebrand disease.”
The study was funded by the National Heart, Lung and Blood Institute. The authors have disclosed no conflicts of interest.
Dr. Jacobson did not respond to a request for comment by press time.
SOURCE: https://bit.ly/2G1FyHZ
Obstet Gynecol 2018.
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