warfarin and Ovarian-Cysts

Anticoagulation poses unique challenges for women of reproductive age. Clinicians prescribing anticoagulants must counsel patients on issues ranging from menstruation and the possibility of developing a hemorrhagic ovarian cyst to teratogenic risks and safety with breastfeeding. Abnormal uterine bleeding affects up to 70% of young women who are treated with anticoagulation. As such, thoughtful clinical guidance is required to avoid having young women who are troubled by their menses, dose reduce, or prematurely discontinue their anticoagulation, leaving them at increased risk of recurrent thrombosis. Informed by a review of the medical literature, we present current recommendations for assisting patients requiring anticoagulation with menstrual management, prevention of hemorrhagic ovarian cysts, and avoiding unintended pregnancy. The subdermal implant may be considered a first-line option for those requiring anticoagulation, given its superior contraceptive effectiveness and ability to reliably reduce risk of hemorrhagic ovarian cysts. All progestin-only formulations-such as the subdermal implant, intrauterine device, injection, or pills-are generally preferred over combined hormonal pills, patch, or ring. Tranexamic acid, and in rare cases endometrial ablation, may also be useful in managing menorrhagia and dysmenorrhea. During pregnancy, enoxaparin remains the preferred anticoagulant and warfarin is contraindicated. Breastfeeding women may use warfarin, but direct oral anticoagulants are not recommended given their limited safety data. This practical guide for clinicians is designed to inform discussions of risks and benefits of anticoagulation therapy for women of reproductive age.

Topics: Anticoagulants; Female; Humans; Ovarian Cysts; Pregnancy; Warfarin

Topics: Anticoagulants; Contraceptives, Oral; Female; Hemoperitoneum; Hemostasis; Humans; Ovarian Cysts; Retrospective Studies; Rupture, Spontaneous; Warfarin

We report three cases of severe haemorrhagic rupture of luteal ovarian cyst requiring surgical haemostasis in young women treated with long-term oral anticoagulation for antiphospholipid syndrome (APS) who used no contraception. At the time of bleeding, the international normalized ratios were 3.78, 4.24, and 7.11. Anticoagulation was resumed post-operatively, in association with antigonadotropic progestins to induce ovulatory suppression. A systematic use of these progestins should probably be discussed in young women receiving long-term warfarin for APS. Ovarian haemorrhage must be considered when such patients develop acute abdominal pain.

Topics: Administration, Oral; Adolescent; Adult; Anticoagulants; Antiphospholipid Syndrome; Female; Hemorrhage; Humans; Ovarian Cysts; Phenindione; Rupture; Warfarin

We describe a case of pulmonary embolism and ischemic stroke due to paradoxical embolism in a healthy young woman taking oral contraceptives to treat an ovarian cyst. It was not possible to identify the site of the thromboembolus. Ultrasound techniques played an important role in identifying the peripheral arterial obstructions and in diagnosing acute pulmonary hypertension. Transesophageal echocardiography provided detailed information on both the morphology and the evolution of the atrial thrombus straddling the foramen ovale within the aneurysmal interatrial septum. The patient was given anticoagulant treatment, initially with heparin and subsequently with warfarin over a period of six months. Repeated ultrasound controls showed no thrombus, regression of the signs of pulmonary hypertension and, lastly unchanged systemic arterial obstruction.

Topics: Adult; Anticoagulants; Cerebrovascular Disorders; Contraceptives, Oral, Hormonal; Female; Heparin; Humans; Ovarian Cysts; Pulmonary Embolism; Thromboembolism; Ultrasonography; Warfarin

A 39-year-old woman presented with progressively severe, sharp abdominal pain of three days' duration. The pain originated in the right lower quadrant of the abdomen and radiated to the back and suprapubic area. It worsened on ambulation and was associated with nausea and loose stools.

Topics: Abdominal Pain; Adult; Anticoagulants; Diagnosis, Differential; Female; Hemorrhage; Humans; Ovarian Cysts; Ovarian Diseases; Thrombosis; Ultrasonography; Warfarin

Women taking anticoagulants are at increased risk of ovarian hemorrhage when they ovulate. Management depends on the patient's clinical presentation and her medical, including obstetric, history. Bilateral oophorectomy should be considered for selected patients on chronic anticoagulation therapy and for those patients for whom reproduction is of no concern. Ovulatory suppression is warranted when conservative therapy is adopted.

Topics: Adolescent; Adult; Diagnosis, Differential; Female; Hemorrhage; Humans; Ovarian Cysts; Ovarian Diseases; Ovulation; Warfarin

Topics: Adult; Anticoagulants; Female; Hemorrhage; Heparin; Humans; Ovarian Cysts; Pulmonary Embolism; Recurrence; Rupture, Spontaneous; Warfarin

Three cases of women in the reproductive age group who received warfarin sodium therapy for pulmonary embolism are presented. The therapy was complicated by rupture of ovarian cysts with intraperitoneal hemorrhage necessitating exploratory laparatomy. The possibility of intraperitoneal hemorrhage must be considered in patients who present with abdominal pain and a history of anticoagulant therapy. Lack of awareness of the complication may result in delay in making a correct diagnosis and instituting appropriate therapy.

Topics: Adult; Female; Humans; Ovarian Cysts; Ovarian Diseases; Pulmonary Embolism; Rupture, Spontaneous; Warfarin

Topics: Adolescent; Adult; Anticoagulants; Cardiac Surgical Procedures; Female; Heart Septal Defects, Atrial; Hemoperitoneum; Hemorrhage; Heparin; Humans; Ovarian Cysts; Ovary; Renal Dialysis; Rupture; Warfarin