A bleeding disorder is a health problem that makes it hard for a person to stop bleeding. Normally when a person is hurt, the body forms a blood clot to stop the bleeding quickly. This clotting process, called coagulation, changes blood from a liquid to a solid state. For blood to clot, the body needs a type of blood cell called platelets, and blood proteins called clotting factors. In people with bleeding disorders, the blood platelets or clotting factors do not work correctly or are in short supply. So, these people bleed longer than normal. With medicine, people with bleeding disorders can lead full and active lives.

Bleeding disorders tend to run in families and can be especially hard to spot in women. More than 2.5 million women in the United States have bleeding disorders and don't know it.

Are there different types of bleeding disorders?

Yes, there are many different kinds of bleeding disorders. The two most common are von Willebrand Disease (VWD) and hemophilia.

What is von Willebrand Disease (VWD)?

Von Willebrand Disease is the most common bleeding disorder. One to two percent of the population or 1.4 to 2.8 million people in the United States has this disease. VWD occurs about as often in men as it does in women.

Women with VWD may have:

• gums that bleed easily
• frequent nosebleeds
• heavy and long menstrual periods
• easy bruising
• heavy bleeding after small cuts, surgery, or dental work

What is hemophilia?

Hemophilia is a well-known but rare bleeding disorder that runs in families. Both men and women have this condition, but almost all people with severe hemophilia are men. However, many women have mild symptoms of hemophilia. This condition is caused by a shortage of clotting factors needed to stop bleeding.

Signs of hemophilia include:

• easy bruising
• excessive bleeding after cuts, dental work and surgery
• blood in the stool or urine

How are bleeding disorders treated?

While there is no cure for bleeding disorders, medicine can control the symptoms. Treatment for bleeding disorders varies. Most women with von Willebrand disease do not need to take medicine at all. People with mild bleeding problems may only need treatment before or after surgery, dental work and injury. More severe cases can be controlled with daily medicines.

Treatments for bleeding disorders include:

• Birth control pills control heavy periods in women with some bleeding disorders. They work by increasing the amount of clotting factors in the blood.
• Desmopressin acetate (DDAVP) is a hormone that makes the body release stored clotting factors into the blood. It can be given as a shot or nasal spray. DDAVP can prevent heavy periods and nosebleeds. It is also used before surgery or to stop serious bleeding.
• Antifibrinolytic (an-tee-fye-bri-noh-LIT-ik) drugs are medicines used to stop blood clots from breaking down. They can be used before dental work, to stop nosebleeds, and for mild intestinal bleeding.
• Clotting factor concentrates contain the blood proteins or clotting factors that are missing from a person's blood. Clotting factor concentrates are injected into a vein or given intravenously (IV). Adding these proteins to the blood prevents or controls bleeding. Different clotting factors are used to treat different kinds of bleeding disorders. Clotting factor concentrates are used when other treatments do not work, for surgery, or serious injury.

Doctors called hematologists have special training in bleeding disorders. They can help you find the best treatment options. With treatment and regular visits to the doctor, women with bleeding disorders can lead full and active lives.

Does heavy bleeding during my period mean I have a bleeding disorder?

Not always. Research shows that bleeding disorders are the cause of heavy periods for about 1 in 5 women. In other cases, heavy periods may be caused by:

• gynecological diseases
• using an intrauterine device (IUD) for birth control
• taking some medicines

Roughly twenty percent of women who see their doctors for heavy periods have a bleeding disorder, most often von Willebrand disease. It is important to keep in mind that even if heavy periods run in your family, it might still be a sign of a problem. So, if you have heavy menstrual bleeding, be sure to ask your doctor about testing for bleeding disorders.

The American College of Obstetrics and Gynecologists (ACOG) suggests testing for von Willebrand disease when:

• a woman is having heavy periods with no known cause
• an adolescent is having heavy periods with no known cause
• a woman is considering surgery to stop heavy periods

Testing should be done before hormone therapy like birth control pills is started.

How would I know if I had a bleeding disorder?

Some common symptoms of bleeding disorders include:

• Very heavy periods
• Regular bleeding from the mouth or gums
• Frequent nosebleeds or nosebleeds that last a long time
• Easy bruising
• Excessive bleeding after injury or surgery
• Bleeding from small cuts for a long time

If you have any of these symptoms, you should discuss them with your doctor. Keep in mind that signs of bleeding disorders in women are often mild.

Research shows that diagnosing bleeding disorders in women is difficult. One study found that women had symptoms for an average of 16 years before they were diagnosed. Plus, since tests can show wrong results many women are told they don't have a bleeding disorder when in fact they do.

Are routine tests for bleeding disorders always accurate?

No, they are not. Screening tests often come out normal even when a woman has a bleeding disorder. This is because many things can affect test results, including:

• Hormonal changes during the monthly cycle
• The use of pain-killers like aspirin
• Taking birth control pills or other hormone therapies
• Pregnancy, childbirth, or breastfeeding
• Blood type
• Intense exercise
• Stress

Tests should be repeated to be sure a bleeding disorder is not overlooked. Women with signs of a bleeding disorder should see a doctor called a hematologist. These doctors will know that tests should be repeated to get a correct diagnosis.

Why is it important to find out if I have a bleeding disorder?

Since bleeding disorders can cause heavy bleeding, exhaustion and depression, finding out that you have one and getting treatment can really improve your life. Studies show that women with untreated bleeding disorders are more likely to:

• miss work
• skip social activities
• become depressed

Untreated bleeding disorders can also cause serious health problems such as:

• Low iron levels in the blood or anemia which causes fatigue
• Severe bleeding with childbirth, miscarriage, or abortion
• Dangerous bleeding with dental work, minor surgery or injury
• Internal bleeding, including bleeding in the brain

All of these problems can be prevented or controlled with medicine. If you have symptoms of a bleeding disorder, talk to your doctor. If you know you have a bleeding disorder, be sure to tell your doctor, nurse, midwife and dentist.

For More Information ...

You can find out more about bleeding disorders by contacting the National Women's Health Information Center (NWHIC) at 800-994-9662