Patient experience and shared decision-making in women's blood health
Women face unique blood clot and bleeding risks throughout their lives due to hormonal changes during birth control use, pregnancy and menopause.
Pregnancy increases the risk of blood clots in your deep veins (venous thromboembolism (VTE) by four to five times compared to non-pregnant women, with the postpartum period carrying an even greater risk.
Understanding these sex-specific risk factors empowers you to recognize warning signs, communicate effectively with healthcare providers and advocate for proper screening and prevention strategies.
Explore evidence-based resources from the ISTH and World Thrombosis Day to help women navigate their unique bleeding and clotting risks.
Bleeding disorders in women
From diagnosis to treatment and beyond, a growing network of global organizations provides education, advocacy and support at every stage of life. Whether you're living with von Willebrand disease, hemophilia, a platelet disorder or another bleeding condition, these resources are designed to help you understand your options, advocate for care and connect with a community that understands your experience.
Birth control and the reproductive years
Hormonal contraceptives can help manage heavy menstrual bleeding in women with bleeding disorders, but selection requires careful consideration of individual clotting factors and bleeding patterns.[14] Combined oral contraceptives, progestin-only methods and hormonal IUDs offer different benefits and risks that should be discussed with a hematologist and gynecologist. If you have a bleeding disorder, you should avoid contraceptive methods that may increase bleeding risk or interfere with clotting factor treatment.[15]
Pregnancy and postpartum
Pregnancy in women with bleeding disorders requires coordinated care between hematology and obstetrics teams starting before conception and continuing through the postpartum period.[16] Factor levels may rise during pregnancy but can drop rapidly after delivery, increasing hemorrhage risk during and after childbirth. Delivery planning should include availability of clotting factor concentrates, avoidance of certain procedures and preparation for potential bleeding complications.[17]
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Menopause and aging
Menopause presents new challenges as declining estrogen levels can affect bleeding patterns, though heavy menstrual bleeding typically improves after menstruation stops.[18] Hormone replacement therapy decisions require individualized assessment of bleeding disorder type, severity and personal risk factors. You should maintain regular hematology follow-up during this transition to adjust treatment plans and monitor for age-related complications.[19]
Managing bleeding risk
Early diagnosis and comprehensive care significantly improve outcomes for women with bleeding disorders across all life stages.[20] Regular monitoring of factor levels, multidisciplinary care coordination and patient education about warning signs help prevent serious bleeding complications.
You should work with specialized treatment centers that understand the intersection of bleeding disorders and reproductive health.[21]
Women with bleeding disorders are not alone
From diagnosis to treatment and beyond, a growing network of global organizations provides education, advocacy and support at every stage of life. Whether you're living with von Willebrand disease, hemophilia, a platelet disorder, or another bleeding condition, these resources are designed to help you understand your options, advocate for care, and connect with a community that understands your experience. Click here to visit our collaborative partners to find support.
Women and blood clots:
Learn more
Women face unique blood clot risks throughout their lives. From hormonal contraception to pregnancy and menopause, certain life stages and medical choices can increase the likelihood of developing blood clots.
Understanding these risks empowers women to make informed healthcare decisions and recognize warning signs early.
Reproductive years and contraception
Hormonal birth control that contains estrogen, including the pill, patch and vaginal ring, can raise a woman's risk of developing a blood clot by three to nine times.¹ That risk is greatest during the first year of use and is especially elevated for women under 30, those who are overweight or those with a family history of blood clots.²˒³
Progestin-only options, such as certain birth control pills, IUDs and implants, do not carry the same risk and are not linked to increased blood clot risk.⁴
Blood clot risk during pregnancy and after delivery
Pregnancy increases a woman's blood clot risk four to five times, but the greatest danger comes after delivery.⁵ The risk jumps 20 times higher during the first six weeks postpartum compared to when not pregnant.⁶ Blood clots in the legs or lungs are a leading cause of pregnancy-related deaths, with most cases happening after delivery.⁷ Your risk increases further if you have a cesarean delivery, are overweight, remain on bed rest or have a family history of blood clots.⁸
Menopause and blood clots
Hormone replacement therapy, or HRT, that contains estrogen in pill form can double or quadruple a woman's blood clot risk, though the overall risk remains relatively low.⁹ How estrogen is delivered makes a significant difference: patches, gels or creams applied directly to the skin do not carry the same increased risk that pills do.¹⁰ The type of progesterone used also matters, as natural micronized progesterone appears to be safer than synthetic versions.¹¹
If you have a personal or family history of blood clots, talk to your doctor about skin-applied estrogen options, which research suggests may be a lower-risk choice for managing menopause symptoms.¹²
Learn more from the
World Thrombosis Day campaign
The International Society on Thrombosis and Haemostasis (ISTH) provides comprehensive information about blood clots in women through its World Thrombosis Day campaign. You can learn about risk factors, warning signs of deep vein thrombosis and pulmonary embolism, prevention strategies and when to seek medical care. Visit www.worldthrombosisday.org to access free educational resources, patient stories and expert guidance on protecting health during critical life stages.
Downloadable resources
ISTH Women's Health resources
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Understanding your risk through life
Women navigate a complex hemostatic balance that evolves throughout their lives, influenced by natural hormonal changes and reproductive events.
Each life stage presents distinct challenges where bleeding and clotting risks intersect, demanding careful clinical management to protect women's health.
Discover how these risks change across the lifespan.
Patient resources and support organizations
Navigating a thrombosis or bleeding disorder diagnosis can feel overwhelming, but you don't have to face it alone. These organizations provide peer support groups, blood clot education and resources specifically for women managing thrombosis and hemostasis conditions during pregnancy, postpartum, menopause and beyond.
Connect with communities who understand your experience and find the guidance you need to advocate for your health.
The World Thrombosis Day campaign educates patients about blood clot prevention, warning signs and treatment options for venous thromboembolism. Patient-focused resources cover pregnancy-related blood clots, contraception safety, heavy menstrual bleeding and women's thrombosis risk factors.
The World Federation of Hemophilia (WFH) supports patients with bleeding disorders through educational resources, advocacy and global treatment access. Women and girls find information on heavy menstrual bleeding, von Willebrand disease, carrier status, pregnancy planning and reproductive health.
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The Foundation for Women & Girls with Blood Disorders provides patient education and clinical resources for women with bleeding and clotting conditions. Find information on heavy periods, bleeding disorders diagnosis, reproductive health, pregnancy management and connecting with specialized care centers.
Page references
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Lidegaard Ø, et al. BMJ. 2009;339:b2890. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726928/
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Martinelli I, et al. Thromb Res. 2016;141:153-157. https://pubmed.ncbi.nlm.nih.gov/27043069/
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American Society for Reproductive Medicine. Fertil Steril. 2017;107(1):43-51. https://www.asrm.org/practice-guidance/practice-committee-documents/combined-hormonal-contraception-and-the-risk-of-venous-thromboembolism-a-guideline-2016/
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Tepper NK, et al. Contraception. 2018;97(1):18-22. https://pubmed.ncbi.nlm.nih.gov/29038051/
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Heit JA, et al. Ann Intern Med. 2005;143(10):697-706. https://www.acpjournals.org/doi/10.7326/0003-4819-143-10-200511150-00006
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James AH. Arterioscler Thromb Vasc Biol. 2009;29(3):326-331. https://www.ahajournals.org/doi/10.1161/ATVBAHA.109.184127
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Centers for Disease Control and Prevention. https://www.cdc.gov/blood-clots/risk-factors/pregnancy.html
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Jacobsen AF, et al. Obstet Gynecol. 2008;111(3):630-632. https://pubmed.ncbi.nlm.nih.gov/18310365/
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Canonico M, et al. BMJ. 2008;336(7655):1227-1231. https://www.bmj.com/content/336/7655/1227
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Scarabin PY, et al. Circulation. 2007;115(7):840-845. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.106.642280
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Renoux C, et al. BMJ. 2010;340:c2519. https://www.bmj.com/content/340/bmj.c2519
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American College of Obstetricians and Gynecologists. Committee Opinion No. 556. Obstet Gynecol. 2013;121:887-890. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/postmenopausal-estrogen-therapy-route-of-administration-and-risk-of-venous-thromboembolism
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van Galen KPM, d'Oiron R, James P, et al. A new hemophilia carrier nomenclature to define hemophilia in women and girls: Communication from the SSC of the ISTH. J Thromb Haemost. 2021;19(8):1883-1887. https://onlinelibrary.wiley.com/doi/10.1111/jth.15397
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World Federation of Hemophilia. Reproductive Health in Women with Bleeding Disorders. Treatment of Hemophilia No. 48. 2009. https://www1.wfh.org/publication/files/pdf-1206.pdf
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Zia A, Kouides P, Khodyakov D, et al. Standardizing care to manage bleeding disorders in adolescents with heavy menses: A joint project from the ISTH pediatric/neonatal and women's health SSCs. J Thromb Haemost. 2020;18(10):2759-2774. https://pubmed.ncbi.nlm.nih.gov/32573942/
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Lavin M, O'Donnell MJ, Kadir RA, van Galen KPM. European principles of care for women and girls with inherited bleeding disorders. Haemophilia. 2021;27(5):837-847. https://onlinelibrary.wiley.com/doi/10.1111/hae.14407
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World Health Organization. Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. 2025. https://www.who.int/publications/i/item/9789240115637
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Connell NT, Flood VH, Brignardello-Petersen R, et al. ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease. Blood Adv. 2021;5(1):301-325. https://ashpublications.org/bloodadvances/article/5/1/301/475399
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World Federation of Hemophilia. WFH Guidelines for the Management of Hemophilia, 3rd edition. 2020. https://www1.wfh.org/publications/files/pdf-2529.pdf
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James AH, Manco-Johnson MJ, Yawn BP, et al. Von Willebrand disease: key points from the 2008 National Heart, Lung, and Blood Institute guidelines. Obstet Gynecol. 2009;114(3):674-678. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756434/
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Lavin M, O'Donnell MJ, Abdul Kadir R, van Galen KPM; EAHAD Women and Girls Working Group. European principles of care for women and girls with inherited bleeding disorders. Haemophilia. 2021. https://academy.ehc.eu/european-principles-of-care-for-women-and-girls-with-bleeding-disorders/