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Potential
causes of excessive menstrual bleeding |
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Healthcare providers consider potential
causes of menorrhagia, including local or systemic disorders.
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Local causes include
uterine and ovarian pathology (benign and malignant), infections,
and local endometrial defects. Systemic pathology includes
endocrine disorders (hypothyroidism and diabetes mellitus),
chronic cardiac and renal disease, liver disease and obesity
which can all influence haemostasis (Table1)
[3].
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In the last decade,
studies have found that from 5-32% of women with menorrhagia
have bleeding disorder [4].
Up to 20% of women with menorrhagia may have von Willebrand
disease (VWD). Menorrhagia is commonly reported in women
with other bleeding disorders, including haemophilia carriers,
with women with fibrinogen, factor II, V, V+VIII, VII, X,
XI and XIII deficiencies, and platelet disorders, which
can be divided into disorders of function ("thrombocytopathies")
and disorders of platelet number such as idiopathic thrombocytopenia
purpura (ITP) and leukaemia [1].
Bleeding disorders can evade diagnosis until menarche, when
heavy menstrual bleeding presents as an unrelated disorder.
However a specific cause of this problem is identified in
only 50% of affected women. |
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table 1
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