From the Research
Von Willebrand factor (VWF) levels fluctuate throughout the menstrual cycle, with notable increases during the late follicular and luteal phases, and typically reach their lowest levels during menstruation and early follicular phase. These fluctuations are clinically significant for women with von Willebrand disease (VWD), who may experience heavier menstrual bleeding when VWF levels are at their lowest during menstruation 1. The cyclical variation in VWF occurs because estrogen enhances VWF production and release from endothelial cells, while also decreasing its clearance from circulation.
Changes in VWF Levels Throughout the Menstrual Cycle
- VWF levels are typically lowest during menstruation and early follicular phase
- VWF levels increase as estrogen rises before ovulation, reaching a peak in the late follicular phase
- VWF levels remain elevated during the luteal phase when both estrogen and progesterone are present in higher concentrations
- These hormonal influences on VWF are clinically significant for women with VWD, who may experience heavier menstrual bleeding when VWF levels are at their lowest during menstruation 2
Clinical Significance of VWF Fluctuations
- Women with VWD may experience improvement in bleeding symptoms during pregnancy when estrogen levels are consistently elevated 3
- Treatments for heavy menstrual bleeding in women with VWD may be timed to address the lower VWF levels during menstruation, using options like desmopressin, VWF concentrates, or hormonal therapies to stabilize levels throughout the cycle 4
- The most recent study on this topic, published in 2018, found that women with VWD had lower levels of FVIII and FX during the luteal phase, which may predispose them to menorrhagia 1