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Von Willebrand's Disease Diagnosed After Menorrhagia Worsened From Levonorgestrel Intrauterine System

Lukes, Andrea S. MD, MHSc*; Perry, Stephanie MD*; Ortel, Thomas L. MD, PhD

doi: 10.1097/01.AOG.0000157758.94890.59
Case Reports

BACKGROUND: Adult females with menorrhagia may have unrecognized mild von Willebrand's disease. Most females with known von Willebrand's disease report menorrhagia.

CASE: A 38-year-old healthy female desired contraception. She described heavy menses lasting 8 days since menarche. History included uncomplicated vaginal deliveries. Physical examination was normal. The levonorgestrel intrauterine system was placed. Her menorrhagia then worsened to 14 successive days each month. Evaluation revealed mild von Willebrand's disease. At 19 months of follow-up, she retained her levonorgestrel intrauterine system and avoided pregnancy. Her menses slowly improved to spotting for 8 days each month.

CONCLUSION: Von Willebrand's disease is a likely cause of menorrhagia that goes unrecognized as well as a potential cause for “failed” conservative treatment for menorrhagia. Understanding the cause of menorrhagia is an important aspect of evaluating this common symptom.

Von Willebrand's disease may help explain why conservative management of menorrhagia may fail.

*Department of Obstetrics and Gynecology and †Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina

Received June 12, 2004. Received in revised form July 29, 2004. Accepted August 12, 2004.

Address reprint requests to: Andrea S. Lukes, MD, MHSc, Director of Gynecology, Women's Hemostasis and Thrombosis Clinic, Box 3463, Duke University Medical Center, Durham, NC 27710; e-mail:

© 2005 The American College of Obstetricians and Gynecologists