Women's Health Community

Dear tabby: Gosh, what a predicament! You are on the blood thinner (warfarin/coumadin) which can make one bleed more heavily--and you cannot use hormones to get the vaginal bleeding to abate. In your situation it is important to identify any other possible causes of the bleeding which can then be treated. For example, in some uncommon cases, a tiny bit of placental fragment can be retained inside the uterus. It will set up a focus for inflection which then creates an unstable uterine lining and erratic bleeding. IF this were the case, treating the low grade infection and/or removing any retained tissue can stop the breakthrough bleeding.

Perhaps your OB/GYN has already evaluated you for other causes of the bleeding beyond the warfarin. If you think he did not, and you don't feel comfortable going back to him, then you should see another OB/GYN for a second opinion.

A lit search at the National Library of Medicine site on your question yielded three citations. Here is the most recent:

Contraception. 2011 Aug;84(2):128-32.
Menstrual problems and contraception in women of reproductive age receiving oral anticoagulation.
Huq FY, Tvarkova K, Arafa A, Kadir RA.
Source

Hemophilia Centre, Haemostasis Unit, Royal Free Hospital, London, UK.
Abstract
BACKGROUND:

Oral anticoagulation is associated with increased bleeding complications. The aim of this study was to assess the changes in menstrual loss and pattern in women taking anticoagulant treatment.
STUDY DESIGN:

Women on oral anticoagulant (OA) treatment at the Royal Free Hospital were interviewed and completed a questionnaire about their menstrual cycle before and after commencing oral anticoagulation treatment. They were then asked to complete a pictorial bleeding assessment chart (PBAC) during their next menstrual bleeding episode.
RESULTS:

Fifty-three women between the ages of 20 and 50 years participated in the study. Of these, 47 women completed a PBAC. The mean duration of menstruation increased from 5 days before starting OA therapy to 7 days after the commencement of treatment. Thirty-one (66%) of the 47 women who completed the PBAC had a score that was greater than 100. The number of women who experienced flooding or clots during menstruation and intermenstrual or postcoital bleeding also increased. In total, 29 (54.7%) women changed their method of contraception during OA treatment. Seventeen women who did not want to become pregnant were not using contraception, including 10 women who were on hormonal contraception prior to starting anticoagulant therapy.
CONCLUSION:

Women of reproductive age experience heavy and prolonged menstrual bleeding whilst on OA therapy. Women of reproductive age on OA therapy should be monitored for menstrual disorders to ensure that prompt and appropriate treatment is instituted. Advice about appropriate contraception should also be part of the medical care provided for these women. Barrier contraception, sterilization and progestin-only contraception are all suitable methods of contraception in this patient group.

Yours,
Jane