Do you screen for VWD in all women with menorrhagia severe enough to cause iron deficiency anemia?

Yes, testing vWF is needed in this situation of severe menometrorrhagia. Excessive menstrual bleeding, especially when severe enough to cause anemia, is a common presenting symptom of vWD in women. The testing should be done as part of a comprehensive workup for gynecologic etiologies and other coagulopathies. I assume that in this case, the platelet count was normal.

Agree, iron deficiency alone is not by itself an indication to screen for VWD. If they have a history of heavy menstruation since menarche and female family members (sister, mother...) with this history of heavy menses since menarche makes the case stronger for screening for VWD. Also, need a full gynecology eval to see if they have PCOS or hormonal issues, fibroid, or endometriosis as well. And many cases, even if they have VWD when OBGYN starts them on OCP, the issue resolves as it raises the ...

Data (albeit very old data) suggests that up to 60% of premenopausal menstruating women have absent iron stores. Menstrual losses are by far the most common cause of iron deficiency in this population, and the menses don't have to be particularly heavy for this to occur. Consider that each pregnancy also uses about 1000 mg of iron, and most premenopausal women who have been pregnant at least once will have iron deficiency.

I believe testing for VWD is warranted in women with menorrhagia, but no...