A 24-year-old with 20 days of constant heavy vaginal bleeding with clots, fatigue, bruising, and regular menses. What is the most likely cause of heavy menses?

A 24-year-old with 20 days of constant heavy vaginal bleeding with clots, fatigue, bruising, and regular menses. What is the most likely cause of heavy menses?

• A. Anovulation
• B. Endometriosis
• C. Von Willebrand disease
• D. Thyroid disorder

Answer: (C)

Heavy menses with clots and accompanying fatigue and bruising point to a bleeding disorder that impairs how platelets form a hemostatic plug. Von Willebrand disease is the most common inherited bleeding disorder and specifically disrupts primary hemostasis. Von Willebrand factor binds to exposed collagen and to the platelet receptor GPIb, helping platelets stick to damaged vessels. When VWF is deficient or dysfunctional, platelet adhesion is impaired, leading to prolonged mucosal bleeding such as heavy menstrual flow. Because VWF also stabilizes factor VIII, there can be a secondary reduction in factor VIII levels, further increasing bleeding risk. This pattern contrasts with other options: anovulation often causes irregular or prolonged shedding but not mucocutaneous bleeding and bruising; endometriosis mainly causes painful periods and infertility rather than heavy bleeding with easy bruising; thyroid disorders can affect cycle regularity but do not typically produce mucocutaneous bleeding or widespread bruising. Therefore, the most plausible cause of heavy menses in this scenario is a von Willebrand disease–related defect in platelet adhesion and stabilizing factor activity.

Heavy menses with clots and accompanying fatigue and bruising point to a bleeding disorder that impairs how platelets form a hemostatic plug. Von Willebrand disease is the most common inherited bleeding disorder and specifically disrupts primary hemostasis. Von Willebrand factor binds to exposed collagen and to the platelet receptor GPIb, helping platelets stick to damaged vessels. When VWF is deficient or dysfunctional, platelet adhesion is impaired, leading to prolonged mucosal bleeding such as heavy menstrual flow. Because VWF also stabilizes factor VIII, there can be a secondary reduction in factor VIII levels, further increasing bleeding risk.

This pattern contrasts with other options: anovulation often causes irregular or prolonged shedding but not mucocutaneous bleeding and bruising; endometriosis mainly causes painful periods and infertility rather than heavy bleeding with easy bruising; thyroid disorders can affect cycle regularity but do not typically produce mucocutaneous bleeding or widespread bruising. Therefore, the most plausible cause of heavy menses in this scenario is a von Willebrand disease–related defect in platelet adhesion and stabilizing factor activity.