Management of heavy menstrual bleeding on anticoagulation

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Heavy menstrual bleeding (HMB) is a common complication of anticoagulation, affecting ∼70% of menstruating women receiving oral anticoagulants. The risk of HMB is lower with apixaban and/or dabigatran than with rivaroxaban. HMB can result in iron deficiency with or without anemia, increased need for medical interventions, decreased quality of life, and missed school/work. Mainstays of treatment include hormone therapies such as the levonorgestrel intrauterine system, subdermal implant, and other progesterone-based therapies, which can result in decreased blood loss and, in some cases, amenorrhea. Combined hormone therapies can be used while patients continue receiving anticoagulation and are also highly effective for decreasing menstrual blood loss. Rarely, procedure-based interventions such as endometrial ablation may be required. Patients should be evaluated for iron deficiency and anemia and offered supportive therapies as needed. Abbreviating the course of anticoagulation or skipping doses can increase the risk of recurrent venous thromboembolism by as much as fivefold, but switching oral anticoagulants may be considered. Awareness of HMB and careful history taking at each visit are crucial to avoid a missed diagnosis.

Original languageEnglish (US)
Pages (from-to)533-537
Number of pages5
JournalHematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program
Issue number1
StatePublished - Dec 2020

ASJC Scopus subject areas

  • Hematology


Dive into the research topics of 'Management of heavy menstrual bleeding on anticoagulation'. Together they form a unique fingerprint.

Cite this