Hotel Dieu de France Beirut Saint Joseph University, Beirut, Lebanon.
Aziza Othmana Hospital, University Manar 2, Tunis, Tunisia.
Haemophilia. 2020 Apr;26 Suppl 3:16-19. doi: 10.1111/hae.13888.
Heavy menstrual bleeding (HMB) is the commonest bleeding symptom among women with inherited bleeding disorders (IBD). Since HMB starts at the very onset of menarche and continues throughout the reproductive life, the health related quality of life of these women is affected and they are at an increased risk of developing iron-deficiency anemia. Because of the entrenched stigma and taboos, women and girls are often reluctant to discuss the problem of HMB within their families and do not seek medical advice. Increased awareness and multidisciplinary management approach for the management of these women are essential in ensuring an optimal outcome. It is important to take a careful history and undertake a thorough gynecological assessment to exclude other underlying/concomitant causes of HMB. Iron supplementation is essential. Strategies for decreasing menstrual blood flow are similar to those used for HMB in general with the addition of desmopressin and replacement therapy and the exclusion of non-steroidal anti-inflammatory drugs. Tranexamic acid and/or hormonal intervention are usually recommended as first-line therapy. Treatment choice should be individualized taking into account whether the woman wishes to preserve her fertility, if she requires contraception, the type of IBD, the severity of bleeding, and her social and religious background as well as acceptability and availability of the treatment options.
月经过多（HMB）是遗传性出血性疾病（IBD）女性最常见的出血症状。由于 HMB 从初潮开始一直持续到生育期，这些女性的健康相关生活质量受到影响，并且她们发生缺铁性贫血的风险增加。由于根深蒂固的耻辱感和禁忌，女性和女孩往往不愿意在家庭中讨论 HMB 问题，也不寻求医疗建议。为了确保获得最佳结果，提高对这些女性的认识并采取多学科管理方法进行管理至关重要。仔细询问病史并进行全面的妇科评估以排除 HMB 的其他潜在/并发原因非常重要。铁补充是必要的。减少月经血量的策略与一般 HMB 相似，除了添加去氨加压素和替代疗法，并排除非甾体抗炎药。通常建议氨甲环酸和/或激素干预作为一线治疗。治疗选择应个体化，考虑到女性是否希望保留生育能力，如果她需要避孕，IBD 的类型，出血的严重程度以及她的社会和宗教背景，以及治疗方案的可接受性和可用性。
