The prevalence of bleeding disorders in women with proven endometriosis: results of a screening study.

Sarah Heynemann, Emma Rachel Accadia, Melissa Cameron, Ray Dauer, Christopher Barnes, Sonia Grover
In: medRxiv · 2023 · doi:10.1101/2023.03.03.23286728 · W4323536551
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found that women with endometriosis have a higher prevalence of abnormal bleeding test results than the general population, and a bleeding score predicts these abnormalities in nulliparous women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper investigated the prevalence of bleeding disorders and associated predictive features in 82 women with histologically proven endometriosis recruited from a tertiary women’s hospital. Using a modified bleeding tendency questionnaire to derive a bleeding score, menstrual blood loss assessment via PBAC (current and heaviest-ever menses), and subsequent coagulation screening in women meeting criteria for significant bleeding tendency (PT, aPTT, PFA-100, and vWF/Factor VIII), the authors found abnormal screening haemostasis tests in 17.72% overall, with 8.54% abnormal vWF tests and 12.99% abnormal PFA-100. The bleeding score showed very good diagnostic performance in nulliparous participants, while individual bleeding symptoms were not predictive; logistic regression suggested combinations of symptoms (including mittelschmerz, cutaneous bleeding, heavy menstrual bleeding, and prolonged minor wound bleeding) were associated with haemostatic abnormalities. Limitations include the screening-based design, reliance on questionnaire- and PBAC-derived measures, and that coagulation testing was performed only in a subset (41/82) who met predefined bleeding-tendency criteria. This paper is centrally about endometriosis — it quantifies the prevalence of abnormal haemostasis screening results in women with confirmed endometriosis and evaluates symptom-based predictors.

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Abstract

Objective: To establish the rate of bleeding disorders amongst women with confirmed endometriosis and clarify predictive features on history. Methods: Eight-two women with confirmed diagnosis of endometriosis were recruited from a tertiary womens hospital. General bleeding tendency was evaluated with a modified internationally standardised questionnaire, and a bleeding score was calculated. Menstrual loss was evaluated by obtaining current and heaviest-ever menses profile using Pictorial Blood loss Assessment Chart(PBAC). Forty-one women satisfied criteria for a significant bleeding tendency and underwent coagulation tests including Prothrombin time(PT), activated partial thromboplastin time(aPTT), Platelet Function Analyser-100(PFA-100) and von Willebrand factor(vWF)/Factor VIII(FVIII) studies. Results : The prevalence of abnormal screening haemostasis tests for the population was 17.72% (95% CI 10.04-27.94) for all tests, 8.54%(95% CI 3.50-16.80) for vWF tests, and 12.99%( 95% CI 6.41-22.59) for PFA-100. Receiver Operator Characteristic curve analysis demonstrated a very good performance of the bleeding score as a diagnostic test for haemostatic abnormalities for nulliparous women with endometriosis. Bleeding symptoms individually were not predictive. Logistic regression suggested the combination of mittleschmerz, cutaneous bleeding symptoms, heavy menstrual bleeding and prolonged bleeding from minor wounds as predictive for haemostatic abnormalities (p=0.0197). Conclusion: The prevalence of abnormal bleeding tests in women with endometriosis on preliminary testing was higher than the population rate of bleeding abnormalities and thus people with histologically proven endometriosis warrant a higher index of suspicion with respect to testing for mild bleeding disorders.

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Condition tags

endometriosis

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References (50)

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