Heavy Menstrual Bleeding and Hormonal Therapy in Women with Type 1 von Willebrand Disease Enrolled on the Zimmerman Program

IntroductionWomen with von Willebrand Disease (VWD) frequently experience heavy menstrual bleeding (HMB), impacting their health and quality of life. Hormonal contraceptives are a standard treatment.AimWe hypothesized that women with type 1 VWD using hormonal therapy would have lower bleeding scores and potentially higher VWF levels than non-users. To test this, we compared demographics, VWF levels, and International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT) scores between hormone users and non-users in the Zimmerman Program cohort.MethodsData from 269 women with type 1 VWD enrolled in the Zimmerman Program were analyzed. Of these, 103 were hormone users, including oral contraceptives (71), medroxyprogesterone acetate (11), levonorgestrel IUD (11), contraceptive implant (3), and the etonogestrel/ethinyl estradiol vaginal ring (1) and (6) subjects were undergoing hormone replacement therapy. Participants who were postmenopausal were excluded from the study results.ResultsHMB was reported by 252 out of 269 participants (94%), with 118 (47%) reporting severe symptoms. While hormone users were younger than non-users, 22.3 versus 23.2 years, (p = .003), VWF levels were similar between groups, (0.36 vs 0.38IU/mL). Age-adjusted BAT scores revealed that in all age groups, more than 70% of patients had abnormal bleeding scores.ConclusionHormonal therapy users had lower total BAT scores compared to non-users, though differences were not statistically significant. These findings suggest a potential but limited effect of hormone use on bleeding phenotype in women with type 1 VWD.