Women and von Willebrand disease.

In 1926 von Willebrand made the observation that 'the trait seemed especially to be seen among women'. A pictorial bleeding assessment chart (PBAC) defines menorrhagia with a score of > 100 representing > 80 ml blood loss. A retrospective study has shown menorrhagia in 74% patients with von Willebrand disease (vWD) and vWD in 13% patients with menorrhagia. Although von Willebrand factor (vWF) increases in pregnancy, there may be an increased incidence of post partum haemorrhage. DDAVP is a useful treatment for menorrhagia and postnatally. Clotting factor concentrates containing vWF may be required.