WOMEN AND MPNS
How MPNs Affect Women
Myeloproliferative neoplasms (MPNs) can affect both men and women. However, there are some important differences in the way MPNs impacts each sex as well as specific issues that affect women who have been diagnosed with an MPN.
Essential thrombocythemia (ET) tends to be more prevalent in women, while polycythemia vera (PV) and primary myelofibrosis (MF) are slightly more prevalent in men.
As a result, women are 1.5 times more likely to develop ET than men, and most often present with a diagnosis of ET rather than PV or MF. But it’s important to recognize that despite the differences in prevalence between the sexes, both men and women can be diagnosed with any of the diseases classified as MPNs.
Diagnosing MPNs in Women
The diagnosis of ET and other MPNs is similar for both men and women, with symptoms ranging from a mild headache or dizziness to nose bleeds, bloody stool, and bleeding gums.
But there are additional issues to consider when evaluating blood cancer symptoms in women. For example, a woman may suffer multiple miscarriages or particularly heavy periods due to an underlying MPN. Also, women with MPNs tend to experience higher platelet counts during menstruation.
Special Considerations for Female MPN Patients
Some women with MPNs tolerate venesections (a simple procedure to reduce the number of red blood cells in your blood) poorly during menstruation. Heavy menstruation needs to be assessed by a gynecologist but can be managed by reducing aspirin dose, low doses of clot stabilizing drugs or a hormone coated device such as the Mirena coil.
The use of combined oral contraceptive either as contraception or to control excessive menstrual loss is not appropriate for female MPN patients due to the risk of venous thrombosis. Other forms of contraception such as the progesterone-only pill are acceptable. Additionally, women undergoing hormone replacement therapy should use the lowest dose of estrogen and avoid it completely if they have experienced a thrombosis.
Pregnancy and MPNs
The chance of a successful pregnancy with ET is about 60-70%, slightly lower than for women with PV or PMF. The development of the placenta, much like the growth of the baby, can be monitored in pregnancy with ultrasound scanning to examine blood flow in the placental blood vessels. Women with MPNs are advised to have an ultrasound scan at least once during the course of the pregnancy.
The primary risk to the mother is thrombosis, especially during the first 6 weeks after the birth of the baby. Extra precautions with heparin are usually advised at this time. As with all pregnancies, the healthier the mother in general, the more successful the pregnancy, so it is important for women with MPNs to maximize their health when planning for pregnancy.
If pregnancy occurs while taking hydrea or xagrid, it’s important to contact your hematologist to determine whether it may be appropriate to safely transition to interferon.
After pregnancy, blood counts rapidly return to previous levels. In fact, sometimes blood counts can overshoot and increase risk, so it’s important to monitor blood count. This is also the time when blood clots happen even to women without MPN, so it is advisable to use heparin for the first 6 weeks and continue with other treatments such as aspirin and interferon.
Below is a brief list of possible questions and topics to discuss with your OBGYN and Hematologist.
Conception and Pregnancy with an MPN
- What’s the risk of miscarriage for someone with an MPN related to the general population?
- What birth control pills can I take that won’t interfere with my MPN medications?
- Are there any drugs or medications I should be taking to increase my chance of carrying to term?
- What drugs are okay to take during pregnancy and breastfeeding?
Delivery and Postpartum with an MPN
- What to watch for if you’re planning a vaginal birth
- What to watch for if you’re planning a cesarean birth
- Post-partum with an MPN
- What are the side effects of treatment options on breastfeeding?
Click HERE to read more about how MPNs can affect women’s reproductive health, written by Dr. Clair Harrison, Professor at Guy’s and St. Thomas’ Hospital and click the links below to read relevant research articles, all about women, pregnancy, and MPN.
- Essential thrombocythemia and pregnancy: Observations from recent studies and management recommendations. Am J Hematol. 2009 Oct;84(10):629-30. doi: 10.1002/ajh.21508
- Predictors of pregnancy outcome in essential thrombocythemia: a single institution study of 63 pregnancies. Eur J Haematol. 2009 May;82(5):350-3
- Pregnancy Outcomes in Patients with Myeloproliferative Neoplasms in the United Kingdom https://ash.confex.com/ash/2015/webprogram/Paper84823.html
- Pegylated-Interferon Treatment Is Safe and Efficient for Pregnant Patients with Essential Thrombocythaemia https://ash.confex.com/ash/2015/webprogram/Paper82990.html
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Learn about Sarah’s ET diagnosis and her experience with starting a family.