von Willebrand disease in women with menorrhagia: a systematic review

Objective To determine the prevalence of von Willebrand disease in women presenting with menorrhagia. Design Systematic review of studies evaluating the prevalence of von Willebrand disease in women with menorrhagia. Setting Hospital outpatient clinics (mainly gynaecological) and population surveys. Population Women presenting with menorrhagia. Methods Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences. Main outcome measures Number of women with von Willebrand disease. Results Eleven studies were included, totalling 988 women with menorrhagia. One hundred and thirty-one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% Cl 11-15.6%). The prevalence was higher in the European studies-18% (95% Cl 15-23%) compared with that in North American studies-10% (95% Cl 7.5-13%). This difference (P = 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race- and ABO blood group-specific values for von Willebrand factor. Conclusions The prevalence of von Willebrand disease is increased in women with menorrhagia and is the underlying cause in a small but significant group of women with menorrhagia across the world. Testing for this disorder should be considered when investigating women with menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms.