SAGP 2023(1) reprint

Introduction

Heavy menstrual bleeding associated with oral anticoagulant use

Heavy menstrual bleeding (HMB) associated with oral anticoagulant (OAC) use, hereon referred to as HMB-OAC, is devoid of evidence-based guidelines for optimal prevention and management. Throughout this article, reference to OAC is restricted to the vitamin K antagonist (VKA), warfarin, and the direct-acting oral anticoagulants (DOACs) currently available in South Africa, such as the direct thrombin inhibitor, dabigatran, and the Factor Xa inhibitors, rivaroxaban and apixaban. A paucity of robust data has persisted in the 30 years since the first documented cases of HMB associated with OAC use. Research was initially impeded by confusingly inconsistent application of terms describing abnormal variations of menstruation (i.e., menorrhagia, metrorrhagia and dysfunctional uterine bleeding)