Oral Contraceptives and DDAVP Nasal Spray: Patterns of Use in Managing vWD-Associated Menorrhagia

Abstract

The purpose of this study was to examine patterns of use for oral contraceptive and desmopressin acetate nasal spray, both used in managing menorrhagia in adolescents with von Willebrand disease (vWD). Hospital records of adolescents with documented vWD and menorrhagia were reviewed retrospectively. Subjects with vWD type 1 (n = 36) administered either oral contraceptives (OC) or intranasal desmopressin acetate (DDAVP) and followed from 6 months to 4 years were selected for inclusion. Treatment outcomes were examined with respect to effectiveness and safety. Assessing menstrual blood loss using PBAC scores from pretreatment and treatment periods determined effectiveness. Safety was evaluated by monitoring reported adverse events. No significant differences were identified in treatment effectiveness for controlling menorrhagia in vWD adolescents in the OC and intranasal DDAVP group comparisons: 86% versus 77% (P > 0.05), respectively. When combining both treatment groups, the majority of vWD adolescents, 81% (P > 0.05), experienced alleviation of menorrhagia symptoms. Treatment failures were attributed to either the inability of a regimen to control bleeding or to adverse events, including severe headaches and flushing with DDAVP. Safety outcomes were not significantly greater in vWD patients with menorrhagia when OC were compared with intranasal DDAVP. Both medical approaches, OC and DDAVP nasal spray, used in managing menorrhagia in adolescents with documented type I vWD were well tolerated and showed equivalent effectiveness, and no serious adverse events were reported.

Menorrhagia in Adolescents with Inherited Bleeding Disorders

“…24,25 In a retrospective study of 36 adolescents with type 1 VWD, intranasal desmopressin was found to be as effective as the COCP in controlling menorrhagia (77% versus 86%, P O 0.05). 26 In our study, six girls (two with type 1 VWD and four with platelet function disorders) reported reduction in menstrual blood loss with the combination of desmopressin and tranexamic acid. Desmopressin is a useful therapeutic alternative to plasma-derived coagulation factor because it avoids the risk for blood-borne infection.…”

Screening Bleeding Disorders in Adolescents and Young Women with Menorrhagia

“…When OCs were compared with DDAVP nasal spray in managing menorrhagia in adolescents with type 1 VWD, they showed equivalent effectiveness. In DDAVP treatment, there were severe headaches and fl ushing [23]. Replacement with iron salts is also essential in the management of these women.…”

von Willebrand Disease in the Pediatric and Adolescent Population

“…73 They are used commonly, however, in reducing the severity of menorrhagia in patients with VWD, even in those with severe type 3. 46,74 In the previously mentioned study by Amesse et al, 69 the use of OC in adolescents with VWD type 1 was also evaluated and revealed that OC alleviated menstrual blood loss, as determined by the PBAC score, in 86% (12/14) of patients. Moreover, the study compared the effectiveness of IN-DDAVP and OC therapy, as assessed by improvement in PBAC score, and showed no statistically significant difference between the two treatment modalities (RR51.109; P5 0.6810; 95% CI, 0.8122e1.515).…”