Real-world data on screening for bleeding disorders in heavy menstrual bleeding: a multicenter retrospective cohort study in the mProve hospitals
Heavy menstrual bleeding is often the first expression of an underlying bleeding disorder in a women’s life. However, bleeding disorders are underdiagnosed. An underlying bleeding disorder is found in nineteen percent until thirty percent of HMB patients. Diagnosing a bleeding disorder is not only important for the treatment of HMB, but also ensures proactive management of bleeding risks during future events like trauma, delivery or surgery. We evaluated clinical practice in the screening for underlying bleeding disorders in HMB by gynaecologists in the mProve hospitals in the Netherlands.
This was a retrospective cohort-study in six hospitals (mProve collaboration) in the Netherlands. Premenopausal women with HMB that visited the gynaecology outpatient clinic in calendar year 2022 were included and data was retrieved from electronic health records with a clinical data collector. Bleeding-related questions, bleeding assessment tool, pictorial bleeding assessment chart (PBAC) and laboratory tests were collected. Referral to a haematologist in suspicion of a bleeding disorder was retrieved.
In total, 3467 patients were included. In 4.9% of the cases, bleeding-related questions, such as bruising or family history, were addressed by gynaecologists during the initial consultation. International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH BAT) was determined in 0.3% of cases, and the PBAC score in 1.0%. Laboratory tests for bleeding disorders such as activated partial thromboplastin time, prothrombin time, fibrinogen or platelet function analyser were performed in 0.1-2.6%. Diagnostic testing for von Willebrand disease (1.6%), haemophilia carriership (1.3%) or thrombopathy (0.6%) were performed sporadically. Referral to a haematologist was performed in 7 patients (0,2%).
This study shows that gynaecologists pay poor attention to screen HMB patients for underlying bleeding disorders, since only ≤4.9% of HMB patients was screened one way or the other. These real-life data demonstrate that awareness and screening for bleeding disorders in HMB patients is insufficient and that drastic improvement is paramount in order to prevent future sequelae caused by undiagnosed bleeding disorders.