Key result
Anticoagulant therapy increases heavy menstrual bleeding risk in reproductive-age women, necessitating personalized management.
Why the study?
Anticoagulant therapy, especially DOAC use in women of reproductive age, increases the risk of abnormal uterine bleeding and heavy menstrual bleeding, which impairs quality of life and often requires therapy adjustments or additional interventions.
This review highlights the necessity of a comprehensive, personalized approach to managing abnormal uterine bleeding in women on anticoagulants—incorporating gynecological consultation, hormonal and anticoagulant adjustments, tranexamic acid, and iron supplementation—to preserve both anticoagulation efficacy and quality of life.
Answers are grounded in this paper and cite their sources.
Supports tailored management of heavy menstrual bleeding in anticoagulated women; leaves open need for randomized trials on strategies.
Anticoagulant therapies, including heparins, vitamin K antagonists, and direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban and dabigatran, are crucial for the treatment and the prevention of venous thromboembolism (VTE). While DOACs offer improved safety profiles, their use, espe-cially in women of reproductive age, increases the risk of abnormal uterine bleeding (AUB), partic-ularly heavy menstrual bleeding (HMB). HMB, defined as blood loss exceeding 80 mL per cycle or causing significant life disruption, is associated with reduced quality of life and substantial economic costs. Women on anticoagulants report higher incidences of HMB, often requiring adjustments in therapy or additional interventions. Management strategies include the referral for a gynecological consultation, the adjustment of hormonal therapy and anticoagulant treatment, the administration of tranexamic acid, and the treatment of iron deficiency. The review underscores the importance of a comprehensive, personalized approach to managing AUB in women on anticoagulants to optimize both anticoagulation effectiveness and patient quality of life.
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Sarlon et al. (2026) conducted a review in Abnormal uterine bleeding / heavy menstrual bleeding during anticoagulant therapy for venous thromboembolism. Anticoagulant therapy (heparins, vitamin K antagonists, rivaroxaban, apixaban, dabigatran) and AUB management strategies (hormonal therapy, tranexamic acid, iron therapy) was evaluated on Abnormal uterine bleeding and heavy menstrual bleeding (>80 mL blood loss per cycle). Anticoagulant therapy in reproductive-age women increases the risk of heavy menstrual bleeding (>80 mL/cycle), requiring personalized management.
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