Menorrhagia and reproductive health in rare bleeding disorders: a study from the Indian subcontinent.

At this centre, 130 women with rare bleeding disorders (RBD) were investigated over the past 15 years. Fifty patients were above the age of menarche (age of menarche in India is 10 years). Of these 44 presented with menorrhagia. Other complications in these patients involved bleeding because of ruptured graffian follicle (1), severe haemorrhage following caesarean section (1), recurrent pregnancy losses (3), hysterectomy to control menorrhagia (2), laser ablation of endometrium (1) and irradiation of ovary (1). Three patients voluntarily chose to remain unmarried because of the problems associated with menorrhagia which they assumed will interfere with married life. All the 45 patients had iron deficiency anaemia. The spectrum of RBD in these patients comprised Glanzmann's thrombasthenia (17), Bernard-Soulier syndrome (2), storage pool disorder (2), factor V (FV) deficiency (3), combined FV and factor VIII deficiency (5), factor XI deficiency (3), factor XIII deficiency (1), factor X deficiency (5), factor VII deficiency (2), alpha(2)-antiplasmin deficiency (1) and afibrinogenemia (3). RBD in women is diagnosed late and often they are not optimally managed hence suffer both iatrogenic and non-iatrogenic complications in this country.