105 Women with VWD and HMB prefer proactive support from providers for treatment of HMB because of HMB. Only 3 of the 11 women had VWD diagnosed before surgery. The participants were all late 40s or older and interviewed several years ago. Their experience may therefore not reflect a broader group of women with mild VWD or women who have not completed childbearing. However, despite the small size of the study, our results were concordant with studies from USA and Sweden. These studies show that a lack of recognition of bleeding symptoms as due to an underlying bleeding disease can lead to increase complications and decrease quality of life in adult women with VWD. They underline the importance of thorough counselling from providers like gynaecologists (15, 16). Another limitation of our study was that women with low educational levels were underrepresented. The women would appreciate it if their gynaecologists and hematologists could involve them in decision- making regarding type of surgery and complication rate. Reynen et al (17) showed that the use of an online website could be an effective method to increase awareness of a bleeding disorder when women are faced with HMB. It is hoped that the experience which these women with moder-ate or severe VWD in our study describes regarding lack of aware-ness of a bleeding disorder and information about type of surgery when childbearing is completed, will be different for young adults tomorrow. Our results may therefore contribute to more research into tailored care in women with VWD and HMB. 6
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