Journal of Thrombosis and Thrombolysis

, Volume 24, Issue 1, pp 39–41

Menorrhagia and minor bleeding symptoms in women on oral anticoagulation

  • Anders Själander
  • Britt Friberg
  • Peter Svensson
  • Lennart Stigendal
  • Stefan Lethagen



Oral anticoagulation (OA) is a common treatment with a known risk of fatal or major bleeding, but also minor bleeding symptoms and menorrhagia can cause substantial discomfort and necessitate medical or surgical interventions. The extent of these side effects is however not previously reported. The objective of this study is to assess the frequency of minor bleeding symptoms and menorrhagia attributed to OA treatment.


Ninety fertile women between 15 and 49 years-of-age on OA treatment completed an inquiry at the anticoagulation clinics of Malmö, Lund and Gothenburg, Sweden.


The frequency of minor bleeding symptoms was significantly increased during OA treatment (P < 0.05) except for hematuria. The incidence of bleeding after tooth extraction (>3 h) increased from 3.0 to 45.2%, easy bruising 17.8–75.6%, epistaxis 11.1–23.6%, gingival bleeding 22.2–48.3% and hematuria 10.0–15.6% (Table 1). Hematemesis was reported in 5.6% prior to as compared to 14.4% during OA treatment, blood in the feces in 8.9 and 18.9%, respectively. Mean duration of menses increased from 5.6 to 6.1 days (P < 0.01) and reported menorrhagia from 44.2 to 70.8% (P < 0.001). Eighteen percent were treated for menorrhagia before and 29.9% during OA treatment (P < 0.01).


OA treatment is known to confer increased risk of fatal or major bleeding. This study shows that fertile women on OA also experience significantly increased minor bleeding symptoms including menorrhagia that may considerably impair quality of life.


Warfarin Oral anticoagulation Menorrhagia Minor bleeding symptoms 



Oral anticoagulation


  1. 1.
    Johansson H (1999) Anticoagulant therapy can be safer: an active follow-up and written care programs reduce the number of complications [in Swedish]. Läkartidningen 96:3388–3390Google Scholar
  2. 2.
    Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, Dángelo A, Pengo V, Reba N, Moia M, Ciavarella N, Devoto G, Merrettini M, Musolesi S (1994) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISOCOAT). Lancet 343:687-691Google Scholar
  3. 3.
    Själander A, Engström G, Berntorp E, Svensson P (2003) Risk of hemorrhagic stroke in patients with oral anticoagulation compared to the general population. J Intern Med 254:434-438PubMedCrossRefGoogle Scholar
  4. 4.
    van Eijkeren M, Christiaens G, Haspels A, Sixma J (1990) Measured menstrual blood loss in women with a bleeding disorder using oral anticoagulant therapy. Am J Obstet Gynecol 62:1261-1263Google Scholar
  5. 5.
    Olsson BS et al (2003) SPORTIF III investigators stroke prevention with the oral direct thrombin inhibitor ximegalatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomized controlled trial. Lancet 362:1691-1698PubMedCrossRefGoogle Scholar
  6. 6.
    Wallentin L, Wilcox RG, Weaver WD, Emanuelsson H, Goodvin A, Nystrom P, Bylock A (2003) Oral ximegalatran for secondary prophylaxis after myocardial infarction: the ESTEEM randomized controlled trial. Lancet 362:789-797PubMedCrossRefGoogle Scholar
  7. 7.
    Schulman S, Wahlander K, Lundstrom T, Clason SB, Eriksson H (2003) THRIVE III Investigators. Secondary prevention of venous thromboembolism with the oral direct thrombin inhibitor ximegalatran. N Eng J Med 349:1713–1721CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Anders Själander
    • 1
  • Britt Friberg
    • 2
  • Peter Svensson
    • 3
  • Lennart Stigendal
    • 4
  • Stefan Lethagen
    • 3
    • 5
  1. 1.Department of Internal MedicineSundsvall HospitalSundsvallSweden
  2. 2.Department of Obstetrics and GynecologyLund University HospitalLundSweden
  3. 3.Department for Coagulation DisordersMalmö University HospitalMalmöSweden
  4. 4.Coagulation CentreSahlgrenska University HospitalGothenburgSweden
  5. 5.Center for Hemostasis and ThrombosisCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark

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