Underlying bleeding disorders need to be ruled out

EDITOR—We read with interest the first in your series of articles on common problems in primary care, on the topic of management of menorrhagia.1 We would, however, like to draw attention to one important aspect that was overlooked, which we believe deserves wider recognition.

Menorrhagia may be a manifestation of an underlying inherited disorder of coagulation. Such disorders are by no means rare. A recent British study found that as many of 17% of women with menorrhagia and no underlying pelvic disease had an inherited bleeding disorder, the most common of which was von Willebrand's disorder.2 An earlier study from Sweden also found the prevalence of von Willebrand's disorder among women with menorrhagia to be 20%.3 The history in the initial consultation should therefore include specific questions to elicit features suggestive of an underlying bleeding disorder. These include …