Review outlines management of heavy menstrual bleeding in bleeding disorder of unknown cause

A case-based review in Blood addresses heavy menstrual bleeding in patients with bleeding disorder of unknown cause (BDUC), defined by a clinically relevant bleeding phenotype despite normal hemostatic testing. The authors use representative clinical cases to summarize available evidence and outline a pragmatic management approach. The abstract reports no sample size or quantitative treatment outcomes.

The authors recommend systematic evaluation for an underlying bleeding disorder in women presenting with heavy menstrual bleeding. Assessment should include a structured bleeding and family history, exclusion of acquired bleeding causes, and comprehensive laboratory investigations. BDUC can be diagnosed when a clinically relevant bleeding phenotype persists despite normal hemostatic results.

Because targeted hemostatic treatments for BDUC are unavailable, the proposed approach is interdisciplinary and multimodal. Options include hormonal therapy, including intrauterine devices, antifibrinolytics and, in selected cases, surgical or other invasive interventions. The authors also recommend targeted screening for iron deficiency, which is frequent in this population and contributes to fatigue and impaired quality of life. Evidence supporting management remains limited; this is a case-based review rather than a comparative treatment study, and only the abstract was available for assessment.