Treatment and Management of Women With Bleeding Disorders

Inclusion Criteria: Referred to study by gynecologist or internist/family practitioner with diagnosis of menorrhagia or referred by self through community advertising or networking Prospective pictorial chart scores of menses >100 Negative pelvic exam and Pap smear within the past year. *Ultrasound if manual exam indicates abnormal uterine size; *Endometrial biopsy if >35 and non-cyclic bleeding; *Rule out acute pelvic diseases - gonorrhea, chlamydia Age 18-50 Willing to go off oral contraceptives and selected drugs (including some nutritional supplements and drugs that affect coagulation such as aspirin and ibuprofen) for initial laboratory testing and throughout the cross-over drug portion of the study Periods at least every 39 days Exclusion Criteria: Patient is not proficient in English Patient is pregnant Patient on hormone replacement, Depo-Provera, or Norplant in last three months Patient has intrauterine device (IUD) present Patient is taking warfarin sodium (Coumadin) or other anti-coagulation therapy History of documented vascular disease (coronary artery disease, cerebrovascular disease or stroke, transient ischemic attack, peripheral vascular disease) Uncontrolled hypertension Insulin dependent diabetes mellitus Chronic renal or liver disease History of seizure disorder History of cancer (other than non-invasive skin cancer) History of venous or arterial thromboembolism Patient with a previously diagnosed bleeding disorder has taken or is taking desmopressin acetate or antifibrinolytic drugs for treatment of heavy menstrual bleeding