The monthly challenge of menstruation as well as the haemostatic challenge of childbirth postpartum renders more females than males symptomatic with
von Willebrand disease. Among vWD patients, the obstetrical and gynaecological morbidity is certainly more pronounced in Type 2,3 patients compared to Type 1 patients, but even in the latter group there is a high proportion of
menorrhagia with associated anaemia, loss of time from work/school and the use of
hysterectomy for ultimate control of
bleeding. Despite the well known adage of the "gestational palliation" of vWD, there is a high proportion of postpartum haemorrhage in Type 1 patients also especially after the first 24 h after delivery. This may occur despite normalization of the
factor VIIIc level in the third trimester, particularly in Type 2,3 patients. With the increasing availability of intranasal/subcutaneous
DDAVP that could be readily administered at home for
menorrhagia, there recently has been ongoing efforts internationally to determine the prevalence of vWD in females presenting with
menorrhagia with a prevalence of 17% combined from two studies of 180 patients total. Issues remain regarding the optimal dose/schedule of intranasal/subcutaneous
DDAVP for
menorrhagia and the relative efficacy of
antifibrinolytic agents. The proper role of
oral contraceptives and
danazol also deserves further study in vWD patients with
menorrhagia. In sum, a comprehensive care approach in females with vWD is warranted analogous to the successful model of care of male haemophiliacs with the intent to (a) reduce unnecessary surgical interventions for
menorrhagia, (b) improve the quality of life during menses and (c) optimize peri-partum management.