Potential causes of excessive menstrual bleeding
 
 

Healthcare providers consider potential causes of menorrhagia, including local or systemic disorders.

 
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].
 
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.
 
table 1
 
 
 
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