[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-448273-105":59,"doc-detail-448273-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","gynecologic-and-obstetric-management-of-girls-and-women-with-von-willebrand-disease","Gynecologic and obstetric management of girls and women with von Willebrand disease","","Among patients first described with von Willebrand disease (VWD), young girls and women faced severe reproductive tract bleeding, prompting modern concern about the risks during heavy menstrual bleeding, conception, pregnancy, and delivery. Persistent monthly blood loss often causes iron deficiency, yet screening and treatment lack consensus, driving underdiagnosis and undertreatment. Delayed recognition in girls and women with reproductive tract bleeding leads to morbidity, fatigue, depression, iron deficiency, and poor quality of life, while uncertainty remains about current therapies and women remain underrepresented in prospective studies.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/gynecologic-and-obstetric-management-of-girls-and-women-with-von-willebrand-disease/448273/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/gynecologic-and-obstetric-management-of-girls-and-women-with-von-willebrand-disease/448273.png","ImageObject",300,407,{"name":92,"@type":93},"Rowan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is heavy menstrual bleeding often the first sign of VWD, and why is diagnosis delayed?","Question",{"text":112,"@type":113},"Heavy menstrual bleeding is commonly the first symptom of VWD, but diagnosis is often delayed for many years due to lack of consensus on screening and treatment and limited recognition of female patients at risk.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What minimal evaluation is recommended for heavy menstrual bleeding?",{"text":117,"@type":113},"A minimal workup includes menstrual history, family history, and bleeding history, plus a complete clinical blood count, ferritin measurement, and a standard gynecologic examination to assess other causes of bleeding.",{"name":119,"@type":110,"acceptedAnswer":120},"How is heavy menstrual bleeding quantified, and what tool is considered the gold standard?",{"text":121,"@type":113},"Heavy menstrual bleeding can be quantified by blood loss; clinically it is commonly assessed using the pictorial blood assessment chart (PBAC), which provides a practical single-score estimate and is described as the current “gold standard,” though it is subjective and variable.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},448273,1791039237,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":36,"preview_page_count":4},1099514067415,"https://ap-avatar.wpscdn.com/avatar/100002539d78ffe74a7?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779092875211072502","REVIEW SERIES  \nGynecologic and obstetric management of girls and women with von Willebrand disease  \nRezan Abdul-Kadir1 and Margaret V. Ragni2  \n1The Royal Free NHS Foundation Hospital Institute for Women’s Health, University College of London, London, UK and 2 Department of Medicine, Division of Classical Hematology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA  \nCorrespondence: M.V. Ragni  \n[ragni@pitt.edu](ragni@pitt.edu)  \nReceived: March 4, 2025.  \nAccepted: April 17, 2025.  \n[https://doi.org/10.3324/haematol.2024.286059](https://doi.org/10.3324/haematol.2024.286059)  \n©2026 Ferrata Storti Foundation  \nPublished under a CC-BY license   \nAbstract  \nAmong the first patients with von Willebrand disease (VWD) described by Eric von Willebrand almost a century ago were young girls and women from a family in the Åland Islands who experienced “genital hemorrhage” so excessive that it led to exsanguination in five members 1 Only recently has attention focused on the risks and challenges that females with VWD face when experiencing heavy menstrual bleeding, conception, pregnancy, and delivery. The persistent monthly losses with heavy menstrual bleeding and increased demands during pregnancy commonly result in iron deficiency, but the lack of consensus regarding screening and treatment leads to underdiagnosis and undertreatment. While the genetics of VWD are known, female members of affected kindreds are infrequently screened and not considered at risk. Among girls and women with VWD in whom reproductive tract bleeding is the most common symptom, a diagnosis of VWD is often delayed up to a decade or more, leading to significant morbidity, fatigue, depression, iron deficiency, and poor quality of life. Furthermore, there is low certainty regarding effectiveness of current therapies and a lack of prospective trials to guide treatment. Novel therapeutics for inherited bleeding disorders are on the horizon, but women are excluded from studies and have poor access to care. While collaborative hematology-gynecology clinics have improved outcomes, females continue to be excluded from decision-making about their own care. Now, 100 years after the first cases of VWD were reported, it is timely to advocate for better care and management of females with reproductive tract bleeding to assure their future well-being.  \nGynecologic considerations  \nHeavy menstrual bleeding  \nAs the first studies of women with von Willebrand disease (VWD) were published, the scope and burden of heavy menstrual bleeding (HMB) began to be realized.2,3 Although HMB is typically the first symptom of VWD, diagnosis was often delayed up to a decade or more later.2 With unabated monthly blood loss, fatigue and anemia were common although unrecognized by healthcare providers, and 25% of these women underwent hysterectomies at a median age of 34 years to control bleeding. However, it was not until the women developed postoperative bleeding requiring transfusion that a diagnosis of VWD was considered, typically precipitated by a call to a hematologist to help manage their postoperative bleeding.2 Unlike women without a bleeding disorder, they had bleeding that lasted for weeks or months beyond the postoperative period.2 Only  \nthen was the bleeding and family history obtained and VWD tests performed, confirming a diagnosis of VWD, and treatment was prescribed to stop the acute bleeding. As these women with HMB became patients at the local hemophilia centers, experience grew in their care and as did proactive collaboration of hematologists and gynecologistsand surgeons, who screened for VWD before surgery, leading to a reduction in postoperative bleeding.  \nDefinition and scoring systems for heavy menstrual bleeding  \nWith the growing understanding of hemostasis and the function of von Willebrand factor (VWF) in facilitating interactions between platelets and the vascular endothelium to form the platelet plug (primary hemostasis) and with other factors to fo","cbCaioBn7JNgEPSI","https://ap.wps.com/l/cbCaioBn7JNgEPSI","pdf",636981,16,"English","# Gynecologic considerations\n## Heavy menstrual bleeding\n## Definition and scoring systems for heavy menstrual bleeding\n## Assessment of the severity of heavy menstrual bleeding","[{\"question\":\"Why is heavy menstrual bleeding often the first sign of VWD, and why is diagnosis delayed?\",\"answer\":\"Heavy menstrual bleeding is commonly the first symptom of VWD, but diagnosis is often delayed for many years due to lack of consensus on screening and treatment and limited recognition of female patients at risk.\"},{\"question\":\"What minimal evaluation is recommended for heavy menstrual bleeding?\",\"answer\":\"A minimal workup includes menstrual history, family history, and bleeding history, plus a complete clinical blood count, ferritin measurement, and a standard gynecologic examination to assess other causes of bleeding.\"},{\"question\":\"How is heavy menstrual bleeding quantified, and what tool is considered the gold standard?\",\"answer\":\"Heavy menstrual bleeding can be quantified by blood loss; clinically it is commonly assessed using the pictorial blood assessment chart (PBAC), which provides a practical single-score estimate and is described as the current “gold standard,” though it is subjective and variable.\"}]","Gynecologic and obstetric management of girls and women with von Willebrand disease | PDF",1790726380]