Consequences of Oral Anticoagulation on Menstrual Bleeding and Contraceptive Use

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Consequences of Oral Anticoagulation on Menstrual Bleeding and Contraceptive Use

OA therapy was associated with heavier bleeding and changes in or discontinuation of contraception.

Among women of reproductive age, information about the effects of oral anticoagulation (OA) on uterine bleeding is limited. Moreover, effective contraception is important because pregnancy risk tends to be high in these women, and warfarin is a teratogen. These investigators evaluated the effects of warfarin therapy on uterine bleeding and contraceptive use in 53 women (age range, 20–55).

Overall, 39 women reported changes in menstrual bleeding with OA use; of these, 27 noted longer duration of flow and 31 had blood-loss scores that indicated heavy bleeding. Likelihood of flooding, passage of clots, and anemia (hemoglobin <12 g/dL) rose with OA use. Among women who changed their method of contraception on the advice of their healthcare provider after beginning OA or who discontinued contraception, 40% reported dissatisfaction with their current method. Seventeen sexually active women were using no contraception, despite not wanting to conceive.

Comment: These data confirm that oral anticoagulation therapy commonly causes heavy menstrual bleeding in women of reproductive age. Although some experts believe that use of combination estrogen-progestin contraceptives is safe in women who receive OA (provided that international normalized ratios remain in the therapeutic range), most study participants who used combination oral contraceptives before beginning OA were advised to discontinue this method of contraception because of potential thromboembolic risk. Sexually active women who require OA should be counseled about their contraceptive options, and clinicians should remember that progestogens or the levonorgestrel-releasing intrauterine system (LNG-IUS) are not contraindicated in such women (JW Womens Health Nov 12 2009). Indeed, depot medroxyprogesterone acetate and the LNG-IUS are preferable for their ability to attenuate or eliminate menstrual bleeding.

— Robert W. Rebar, MD

Published in Journal Watch Women's Health September 1, 2011

Citation(s):

Huq FY et al. Menstrual problems and contraception in women of reproductive age receiving oral anticoagulation. Contraception 2011 Aug; 84:128.

Medline abstract (Free)

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