Sara Wyen is a writer and founder of Blood Clot Recovery Network, a site that helps patients through the recovery process from deep vein thrombosis* or pulmonary embolism*. Her own story about a freakishly heavy period while taking her anticoagulant medication is a good one to share with any women you know who are prescribed these drugs. . .
Sara was just 29, a runner (even a coach of other runners), eating right, and beginning what she calls her dream career – when her life was forever changed after an undetected blood clot in her leg suddenly broke free and lodged into her left lung.
“I went from being happy, healthy and sure of the direction my life was taking to being gravely unhealthy, unsure of anything, and in the worst pain I could ever recall.”
Sara was discharged from the hospital on low molecular weight heparin blood thinning injections. Heparin is an anticoagulant drug that treats and prevents the formation of blood clots, often used in patients after heart attack, atrial fibrillation or any condition linked to an increased risk for blood clots. Anticoagulants are sometimes called “blood thinners”. They don’t actually thin your blood, but they can help prevent blood clots from forming.
Sara now advises women who start taking anticoagulants that the first question to ask their doctors should be:
“Should my menstrual cycle be this heavy while taking anticoagulants?”
Sara says she worried if heavy periods would become a major issue for her, since she had already struggled for a long time with uncomfortable periods.
Although her periods were more frequent and slightly heavier at first following treatment for her blood clot, her menstrual cycle eventually returned to what had been “normal” for her – “unpredictable, but mostly manageable.”
But one day, her period arrived at the regular time yet significantly heavier than usual. Sara says she wasn’t alarmed – at first.
“My first thought was, ‘Good. I’ll get it all out of the way in a day or two!’ I began to grow more and more concerned as the third day of my cycle arrived, and the bleeding worsened. By that time, I was going through a 10-hour pad in less than one hour, and I was soaking through my clothes. My doctor instructed me to go immediately to the Emergency Department, which I did – now completely panicked about my situation. After several hours, it was determined that I had uncontrolled uterine bleeding. In my case, it was a period that wasn’t stopping. The cause was an INR level that was way too high, which I did not know about. I needed a reversal treatment (oral vitamin K), to help bring my INR back into a safe range. I am very fortunate that I did not need a blood transfusion. The Emergency staff told me repeatedly that it was good I came in when I did because the bleeding may not have stopped on its own.”
Sara explained that although this was a extremely scary experience which took several weeks of medication adjustments, blood draws, and ultimately bridging with injections to stabilize her INR, it’s a lesson that she takes very seriously.
And if she experiences abnormal bleeding like that again, she’s determined not to simply assume that it’s “just” her period – because now she knows that something could be seriously wrong.
Researchers have studied heavy menstrual bleeding incidents like Sara’s as the use of anticoagulants and/or anti-platelet treatments has increased to reflect the growing number of pre-menopausal female patients with cardiovascular disease.
A 2019 study, for example, estimated that the prevalence of heavy menstrual bleeding in pre-menopausal women under age 50 increased from 18% before anti-clotting therapy to almost 30% afterwards. Yet cardiologists or vascular specialists caring for pre-menopausal patients may fail to refer these women to a gynecologist – or even ask about their menstrual problems.(1)
A European study led by Dutch cardiologist Dr. Angela Maas studied the dual anti-platelet therapy commonly prescribed to women after having a coronary stent implanted. This typically includes taking aspirin plus an anti-platelet drug like clopidogrel (Plavix) or ticagrelor (Brilinta). Dr. Maas and her colleagues conclude that “treating pre-menopausal heart patients demands specific expertise and close collaboration between cardiologists and gynecologists.”
And equally important, they recommend that more safety data on uterine bleeding in pre-menopausal women who are taking the newer “novel” anti-platelet drugs should be obtained before drugs are approved. This is a concern for all younger women taking these drugs, given how under-represented women have been in cardiac drug trials. See also: Is It Enough to Have “Enough” Women in Cardiac Studies?
Meanwhile, what do pre-menopausal women do if they experience abnormally heavy menstrual bleeding while taking these prescribed meds? There are solid reasons your physicians recommend your anticoagulants or anti-platelet drugs – stopping suddenly can lead to dangerous blood clots. But living with heavy menstrual bleeding can also carry both physical and psychological dangers of its own.
For more info, read about current drug, device or surgical treatment options on the Mayo Clinic website.
Read Sara Wyen’s full story here – including four key questions she recommends all women who have heavy periods while taking blood thinners must ask their doctors.
Doing so, she believes, may prevent the frightening emergency interventions that she had to go through.
Image: Mabel Amber, Pixabay
- deep vein thrombosis: a serious condition that occurs when a blood clot forms in a vein deep inside your body – typically in the thigh or lower leg but may also occur in other areas
- pulmonary embolism: a serious condition caused by a blockage in one of the arteries in your lungs, in most cases, caused by blood clots that travel tn the lungs from deep veins in the legs or other parts of the body (deep vein thrombosis)
- anticoagulant medication: (also called “blood thinners”) – they don’t actually thin your blood, but they can help prevent blood clots from forming
- heparin: an anticoagulant that treats and prevents the formation of blood clots, often used in patients with heart attack or atrial fibrillation
- INR: (International Normalized Ratio) a measurement of how much time it takes for your blood to clot: a low INR test result means your blood is not ‘thin’ enough or coagulates too easily and increases risk of developing a blood clot; a high INR result means your blood coagulates too slowly and increases the risk of bleeding
- warfarin: (brand names: Coumadin, Jantoven) an anticoagulant drug that’s used to prevent or treat blood clots, including deep venous thrombosis or pulmonary embolism, also used for blood clots that may be caused by certain heart conditions. Other newer anticoagulants include dabigitran (Pradaxa), rivaroxaban (Xarelto), edoxaban (Lixiana or Savaysa) or apixaban (Eliquis) – also used by heart patients who are at moderate-to-high risk of a stroke
- vitamin K: a group of vitamins that your body needs for blood clotting and helping wounds to heal
- anti-platelet drugs: a class of drugs that inhibit the platelets in your blood from clumping together. Platelets are small particles that can stick together to form blood clots, potentially leading to heart attack and to the sudden clotting of a coronary stent. Aspirin (ASA or acetylsalicylic acid) is the most common antiplatelet drug; at a low dose, aspirin reduces inflammation in the arteries, which is why doctors recommend taking aspirin if you think you’re having a heart attack.
Resources: Heart and Stroke Foundation, Mayo Clinic, National Heart Lung & Blood Institute, American Heart Association
1. Gu ZC et al. “The Management of Heavy Menstrual Bleeding After Percutaneous Coronary Intervention in a Woman of Reproductive Age.” Front Pharmacol. 2019; 9:1573. 2019 Jan 15.
2. Maas AH et al. “Practice Points in Gyne-Cardiology: Abnormal Uterine Bleeding in Premenopausal Women Taking Oral Anticoagulant or Antiplatelet Therapy.” Maturitas. 2015 Dec; 82(4):355-9.
Q: Have you experienced heavy periods associated with your anticoagulant meds?
NOTE FROM CAROLYN: I wrote more about cardiac medications in my book A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press). You can ask for this book at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press. Save 20% by ordering this book directly from Johns Hopkins University Press, using the code HTWN .
-Visit Sara Wyen’s site Blood Clot Recovery Network