womens' issues questions

[thecman321]

My 32 year old wife is wondering what type of effect will coumadin have on mestural cycles? (quality, quantity,pain,bloating,moods,libido,birth control options, etc.)
Any premenapausal women out there willing to share their coumadin experience with this regard???
thanks

 

[Ross]

http://www.warfarinfo.com/faq.htm

http://www.warfarinfo.com/pregnancy.htm

http://www.warfarinfo.com/family-planning-with-venous-thrombosis.htm

Go get a great Coumadin education at Al Lodwicks site. It'll answer most, if not all of your questions. I'm sure others will put in there two cents too.

 

[Mary]

My experience has been confined to using Plavix and a low dose aspirin, but the bleeding was so prolonged and heavy that I stopped taking both. I have talked to a few other women on the site privately, and their experience with coumadin is similar to what I encountered.

My decision not to go mechanical is largely based on this consideration.
Mary

 

[Sherry]

I had mine done at 33 and have had difficulties with very heavy cycles. I've never found a doc who will prescribe any kind of b.c. for me because of clotting issues. I'd be happy to converse with her through private messages or e-mail if she wants to.

 

[Gnusgal]

I was not given a choice when I got my new valve. I was just told I was getting a mechanical. I had not yet found this site, or I might have pressed for more information as to why. At any rate, when I was put on coumadin I was told I needed to be taken off of bc pills that contained estrogen because of the clotting risks (but they wanted me on some sort of bc because of how dangerous pregnancy would be). So I was put on a progestrin-only pill. Less than a year later I ended up having emergency surgery because an ovarian cyst had formed and burst. The coumadin meant that the bleeding from the burst cyst did not stop and they had to go in to stop the bleeding. It was a much more dangerous situation than I realized at the time. Now I am back on bc pills WITH estrogen. The gyno. consulted with a hemotologist, who said that I'm anticoagulated with the coumadin, so there really isn't any reason to worry about bc pills causing blood clots. The bigger worry for me is that I would form another cyst and end up in another internal bleeding situation. So it IS possible to be on bc pills and coumadin at the same time. You just might have to look for a doc who is willing...

Keep in mind that every woman is different. My experiences are unique. I did not share them to scare anyone, just to show that it is possible to be on coumadin and bc pills. And for those who are not at risk for cysts, the progestrin-only pills would be fine, I'm sure. I didn't even know I was at risk for cysts until things went so horribly wrong. I'd been on bc pills for so long already that it had never been an issue until they were changed.

As for heavier flow, yes, my period is heavier. But not to the point where it's unmanageable. I think that is because of the bc pills, though. If not for that, who knows!

Good luck to you and to your wife!

 

[Sherry]

Niki, I'm glad you posted your response; now I'm going to bring it up again with my gynecologist to see if she'll consider it for me. Here I am almost eight years out and still within my childbearing years, and I've never really known of others on this board who have managed coumadin and bc pills until reading your reply. (I guess it really doesn't get brought up here, or if it does, I must have missed it.)

 

[Guest]

I don't think that I have ever seen a woman who was on warfarin who developed a blood clot due to bc pills or estrogen replacement.

The "third generation" - the newest bc pills are highly estrogenic and are more likely to cause clots that the "second generation" pills.

I have never seen any caution against a woman taking bc pills while on warfarin. This is probably one of those cases where the fact is that estrogens cause clots in women who are not taking warfarin, so the doctors jump to the conclusion that it uis not wise to take them while on warfarin. However, you cannot extrapolate from one situation to the other.

I have seen hundreds of women of child bearing age on warfarin and cannot remember any who stopped warfarin because their periods were unmanageable. That should not be a primary consideration in which valve to choose. The effect of warfarin on the fetus might influence your decision.

 

[Guest]

We have a member who works for one of the companies that makes bc patches. This person did not think it would be ethical to post a message about a product form their company. However, I received a private message reminding me that patches do not seem to produce clots. I think this is because they do not go directly to the liver when absorbed.

Thanks to this person for their professionalism.

 

[Mary]

I have seen hundreds of women of child bearing age on warfarin and cannot remember any who stopped warfarin because their periods were unmanageable. That should not be a primary consideration in which valve to choose. The effect of warfarin on the fetus might influence your decision.

Al,
Maybe you haven't had any woman discuss it with you, but it is a very real problem.

 

[Guest]

At my clinic we follow up very carefully on why people stop coming to the clinic because their physicians' expect us to be totally responsible for their warfarin management. I don't doubt that it is a problem for some women, because many have discussed the problem with me. However, I will stand by my statement that none have reported that this was the reason for stopping warfarin. I have managed warfarin for about 100 women with antiphospholipid syndrome. This condition can cause clotting in any blood vessel at any moment. I've seen loss of eyesight, kidney failure, a stroke at age 17, several debilitating strokes of women in their 20s, heart attack at age 10 etc. Warfarin is not even a very efficient drug to prevent this condition but there is not one of them that has seriously considered stopping warfarin because of heavy periods.

The real problem with excessive bleeding is anemia. The true measure of serious anemia is whether or not you need a transfusion. Any woman who needs a transfusion because of a heavy period, has a gynecological propblem. It is not due solely to warfarin.

Consider also that what is lost during a period is not true bleeding. It is blood rich tissue that has already died and been replaced by fresh tissue underneath. It is not the same as a cut. It may appear heavier because the blood is not clotted as efficiently as before warfarin, but my guess is that there is not actually any more blood being lost.

Some people have low tolerance for nusiances. That is a personal preference. Nothing I write will change that and I am not trying to. What I am saying is that before anyone makes a decision about what type of valve, they need to get all of the facts and put them in with their personal preferences. Some people who choose tissue valves wind up with atrial fibrillation and are on warfarin anyhow. You may decide that heavier periods are sufficient justificattion in your mind to undertake the risk that you will outlive a tissue valve. That is fine, it is your decision. We all face these all of our lives.

Those of you who have been on this board for more than one year know that I agonized over the same type of decision about this time one year ago. I was diagnosed with prostate cancer. There was a new treatment (freezing) that causes minimal problems at the time of surgery but is unproven over the long run. Should I choose that or the more conventional treatment that leaves you with a long recovery time but has a good track record for longevity. I chose the freezing and now almost one year post-op, I appear to be cancer free.

Whatever you choose, you have to say, "I got all of the information that I could and made the decision that seemed right for me at the time." There will be new devekopments that will make you think, what if... But you cannot dwell on that. You have to make the decision that you are content with.

 

[Mary]

Al,
Maybe you haven't had any woman discuss it with you, but it is a very real problem.

Al,
I'm not questioning your statement that none have reported stopping using warafin due to excessive periods. This was a question posed about pros and cons of a mechanical or tissue valve. I said it is a very real problem and it is possible women don't discuss it with you.

The thread poses a question from a man who asked if any WOMEN were willing to share their experiences (Womens' Issues Questions is the name of the thread). I shared that this was an issue that I had only heard about on the VR forum via private messaging. It is not a topic that is brought up on a consistent basis. Actually, this is the first mention I've seen of it at all. So, as a Woman, I chose to respond.

My OB/GYN defines excessive menstrual bleeding as an amount that causes a woman to go through more than 9 pads or tampons a day. While on Plavix, which I understand is not warafin, I was going through 15-20 a day--for 7-8 days at a time. This is more than a nusiance. I teach school, and some days I might be unable to get a restroom break for three or four hours. Other women have indicated similar experiences. Low tolerance? I think not.

This has been my experience, and the experience of others. Labeling it as low tolerance for nusiances sounds sexist to me, and I'm not PMSing.

 

[Lisa in Katy]

Anyone with a mechanical valve who would stop warfarin because of unmanageable periods would be stupid, and possibly dead.

As I've discussed previously, mine were fine before surgery and Coumadin, and then extremely heavy and prolonged afterwards. My first period post surgery began in the hospital - two weeks early - which was probably due to stress. After two years of dealing with 3 weeks of heavy bleeding with 1 week of light spotting before a repeat, no gynecological problems were discovered, and since I was only 36 when I had surgery, I had many years of periods left. The gynecologist and hematologist both decided that the bleeding and resulting anemia (treated with Iron - YUCK!) were probably a result of the Coumadin. So, the recommendation was a hysterectomy of a very normal uterus. BTW, I could never take birth control pills because they raised my blood pressure. I had my tubes tied at age 31 after my second child was born so was of child bearing age at the time of the hysterectomy, but not able to get pregnant. Thus, my decision to go forward with the surgery was easy.

 

[Guest]

There are many hematologists who say that warfarin does not cause bleeding on its own. It causes things that are abnormal to start bleeding sooner than they would have on their own. Many people owe their lives to warfarin starting bleeding in the colon etc and when it was checked out found early stage cancer.

I'm very knowledgable about Plavix. It seems a rather strange drug to me. Its benefits seem largely dreamed up by marketing people.

 

[Missy]

I am a woman and I agree with Al. I was told the same thing as Al said by my surgeons office and cardiologist office. Mentrual bleeding is different than other bleedings. I was told I could even have surgery while on my period as heparin would not effect it. It is already there and going off or on coumadin would not effect that. I thought my surgery would be scheduled around my period but not so. Fortunately for me I didn't have that happen. I have always had a heavy period and still do. But I see no difference than before when I wasn't taking coumadin.

 

[Gail in Ca]

Medical people used to tell us women that mentrual cramps were all in our heads.
I believe that open heart surgery affects women immediately no matter what type of valve is placed, but especially after one is on coumadin. I had a period in the hospital for both surgeries, when it wasn't due. My GP said it's amazing the body does this, to keep us from getting pregnant, makes sense to me.
I was 34 for my 1st avr( porcine), and my periods were never the same after that one.
Closer together and longer. But, after my 2nd avr(mechanical), and on coumadin it was very much different and NOT in a good way. From the 1st period at home after surgery, it was Heavy, Heavy and lasted 10 days or more. Then, my period came only 12-14 days later. I had a few periods that were so heavy , I changed a super plus tampon every 45 minutes for hours the first 2 days. My ob put me on progesterone and that seemed to help some months and other months not at all.
I was very happy when my periods stopped altogether. Now that I have hot flashes pretty bad, my cardiologist is rethinking his view of the past that I not take estrogen. He said I could discuss it with my GP and it would probably be ok to take it. I haven't yet, I'm trying natural methods first.
So, to sum it up, expect changes and major ones if she gets mechanical and is on coumadin.
Gail

 

[joy]

I am a woman, who chose not to have a mechanical valve, not because move the menstrual issues of coumadin, but...I ended up on it anyways, and I have VERY heavy periods, but they only last like 3 days and then they are gone. I go through 1 super plus absorbancy tampon an hour during these 3 days, and I know this is gross, and for all you guys who don't want to know, don't read this post. Most of my underwear and light colored jeans are RUINED because it leaks. I choose not to get into the rest because of the content, but your wife can PM me any time.

 

[McCln]

Here is of my own experience. I was always a heavy bleeder. Once on the warafin(coumadin) I bled more due to not making clots. So I am on birth control shots, depo-prevra. It also helps in keeping one from becoming anemic. The other choice, hysterectomy. So, the choice is hers if she goes on warafin(coumadin). I can't have surgery due to anothe heath issue, diabetes. But she has to make a choice of which way she wants to go. Thanks for coming in to get information from the source. You are a good hubby.

 

[Guest]

I didn't try to say that it was all in your heads. I've been married since 1964, I learned not to do that longer ago than most of you have been alive!! I was saying that there are many other reasons besides warfarin that could be the cause. Sometimes warfarin gets blamed for things when it is just there as a marker for the real cause. Didn't the heart surgery change your state of health? There is no way to settle the discussion because we can't randomize women before the surgery to warfarin and no-warfarin groups.

As far as wrecking light-colored jeans. I can identify with that. I had prostate surgery last March and rarely wear light-colored pants anymore.

 

[joy]

I think it depends on how many kids you have had as well. Before I had my kids, I used to get cramps really bad, now I don't. I have other pains, since I had 2 c-sections, I have pain at the site, I don't remember what those things are called, but they are often found in scar tissue, and they hurt! I have to lay on my right side or I am in excruciating pain...hard to go to the dentist or to go to get my echos done, since with both of them you are laying either on your back or on your left side. I asked the docs if they could do something about it, but they said that it would be dangerous because of all the stuff that is down there like my colon, and all that fun stuff. Luckily I already had two kids, and since Kevin's vasectomy failed, I had my tubes tied because of my heart. They said I would never make it through another pregnancy. Al, I wasn't saying anything bad about your posts, I know that scientifically, it shouldn't affect our menstrual cycles. By the way...when I had my surgery, I had 3 periods in a row. Stress on your body will do that to a lot of women. It gets better though, trust me!

 

[Shelba]

I am 32, and had valve replacement last March and I am on coumadin. Before coumadin, I had a bit of a warning that my period was coming...in the form of spotting. Now that I am on coumadin, my period arrives with a gusto. Like Joy mentioned above, it is heavy for the first three days and that is it. It has not been an issue for me. At all.

Okay, I tried talking about this without getting too graphic. Hope I was successful.

I have not been on the pill since my surgery, but I think I am going to check into going back on it. I'm curious to see what my doctor's will say.