Anticoagulant therapy linked to abnormal menstrual bleeding in women

EUROPE: According to findings from a prospective trial published in Blood, abnormally excessive menstrual bleeding occurred in two-thirds of women of childbearing age who started taking anticoagulants for acute venous thromboembolism in the months after therapy began.

The study also revealed that women's quality of life was reduced when they used anticoagulants and experienced heavier bleeding.

"Unusual uterine bleeding affects many women, but it is more common in reproductively active women who use anticoagulants. There are still no precise estimates of the frequency, prevalence, or effects of anticoagulation-induced irregular menstrual bleeding," asserted the authors.

The purpose of this study was to collect high-quality prospective data on the incidence, prevalence, and relevance of unusual uterine bleeding among women on anticoagulant therapy due to acute venous thromboembolism to determine the burden of this condition in this population of women.

Ninety-eight women with functional menstrual periods were enrolled in the prospective, multicenter TEAM-VTE study (mean age, 34 9.4 years). Using Pictorial Blood Loss Assessment Charts (PBAC), researchers calculated the amount of blood lost during each woman's last period before receiving a VTE diagnosis and during every subsequent period over the 3- to 6-month follow-up phase. By using elevated PBAC scores of greater than 100 or larger than 150, the study determined that abnormal uterine bleeding was either self-reported or measured. The study's primary endpoints were incidence of new-onset abnormal menstrual bleeding and frequency of abnormal uterine bleeding overall. Modifications in quality of life brought on by atypical menstrual bleeding were among the secondary outcomes. Using the Menstrual Bleeding Questionnaire, investigators further assessed quality-of-life scores associated with abnormal uterine bleeding at baseline and after the study's follow-up period (MBQ). Due to a slow participation rate during the COVID-19 pandemic, the researchers decided to end the trial early.

Key results of the study:

• During the follow-up phase of the trial, 65 (95% CI, 57-75) of 98 women (66%) satisfied the criterion of abnormal uterine bleeding.
• 36 (95% CI, 47-71) of 60 women (60%) had new-onset unusual uterine bleeding episodes that started after the diagnosis and beginning of VTE treatment.
• During baseline assessment and the termination of anticoagulant medication or the 6-month follow-up visit, there was a mean increase in MBQ score of 5.1 points (95% CI, 2.2-7.9), which was associated with a significant deterioration in quality-of-life ratings among women with abnormal bleeding.

According to the study's findings, the authors concluded that women of reproductive age who are receiving anticoagulant medication had a significant frequency of abnormal uterine bleeding.

"This is something VTE caregivers should be aware of, take action about, frequently check menstrual blood loss in all women with a new VTE diagnosis, and address incident abnormal uterine bleeding appropriately," they added.

REFERENCE

Cindy MM de Jong, Marc Blondon, Cihan Ay, Andrea Buchmüller, Jan Beyer-Westendorf, Judith Biechele, Laurent Bertoletti, Giovanna Colombo, Marco Paolo Donadini, Stephan V Hendriks, Luis Jara-Palomares, Stephan Nopp, Pedro Ruiz-Artacho, Pauline Stephan, Cecile Tromeur, Thomas Vanassche, Peter E. Westerweel, Frederikus A Klok; Incidence and impact of anticoagulation-associated abnormal menstrual bleeding in women after venous thromboembolism. Blood 2022; blood.2022017101. doi: https://doi.org/10.1182/blood.2022017101