PB0685 - A retrospective review of Heavy Menstrual Bleeding in women with inherent bleeding disorders – a need for Joint Gynaecology-Haematology clinic

Background: There is a clear recognition that menstruating women with inherited bleeding disorders (IBD) experience heavy menstrual bleeding (HMB). There is often a long delay between haematological and gynaecological reviews in UK practice. The Guidelines produced by the UK Haemophilia Centre Doctors’ Organisation have recommended combined clinics (Haematology and Gynaecology) to expedite treatments.

Aims: To retrospectively evaluate incidence & management of HMB in IBD in Leicester Haemophilia Comprehensive Care Centre.

Methods: A local database was used to identify women in reproductive age group who had suffered HMB and had an IBD diagnosis. HMB is defined by NICE for clinical purposes as excessive menstrual loss, which interferes with a woman’s physical, social and emotional and/or material quality-of-life (QOL). Detailed information on the following characteristics was obtained: baseline factor levels; HMB details including PBAC score, pattern of Hb and ferritin, duration of period, frequency, if clots passed; treatments used; blood transfused, pelvic scans, and related hospital admissions in addition to QOL.

Results: A total of 251 women in age group of 12 to 55 years were included in the assessment. 100/251 (39.8%) had HMB. Of these, 45/100 (45%) required hormonal treatment & 79/100 (79%) required one or more non-hormonal treatment such as Tranexamic acid, Desmopressin or factor concentrate; 6/100 (6%) required hysterectomy surgery; 33/100 (33%) required iron supplementation or blood transfusion therapy. 39/100 (39%) had Gynaecology review. Inadequate documentation of QOL is noted: 11/100 (11%). The details of the type of IBD and treatments used are listed in Table 1.

Conclusion(s): There is considerable morbidity amongst women with IBD experiencing HMB from delays in multi-specialty reviews and is a common finding in the UK. Current care of this group of women can be further improved by inception of joint Gynaecology-Haematology clinic as supported by our presented data.