Menstruation--still a contraindication to elective surgery?

Menstruation is a physiological phenomenon of cyclic endometrial exfoliation caused by changes in the level of sex hormones (estrogens and progesterone), under the system of mutual feedback between the gonads, the anterior pituitary gland, and the hypothalamus. Amongst surgeons, there is belief that menstruation is a contraindication to elective surgery. This is attributed to the functional impairment of the coagulation system and accompanying pain during the postoperative period, which may interfere with the general picture, and thus, possibly delay the diagnosis of postoperative complications. In view of the contraindications the aim of the study was to review literature data for evidence confirming or negating this thesis, according to evidence-based medicine. The PubMed, Ovid Medline, Science Direct and Springer databases were browsed through using a combination of the following words: “menstrual cycle”, “intraoperative bleeding”, “contraindication to elective surgery”, and “blood loss”. Considering the above-mentioned, 452 studies were found. After abstract analysis, 421 were discarded. Thirty-one studies were qualified for full-text analysis, off which 12 were rejected. Finally, 19 studies were included in the methodology of the mentioned problem. Amongst the many complications concerning the functioning of the coagulation system during the menstrual cycle, one should initially quote the systematic review undertaken by Konol et al. in 2012. The authors gathered 30 of the best publications concerning the issue. Analysis considered studies assessing platelet function, von Willebrand’s factor (VWF), factors VIII, IX, X, XI, XIII, D-dimers, plasminogen activator inhibitor (PAI-I), tissue plasminogen activator (tPA), alpha2-antyplasmin, and the fibrinogen level. In most studies cyclic changes of the above-mentioned were not observed. In isolated cases where such changes were observed the lowest level of these factors (especially VWF, FVIII, and platelet factor activity) was diagnosed during menstruation. It should be noted, however, that the above-mentioned reduction did not exceed 10% of initial values, not having any clinical implications. The main conclusion following the systematic review of the above-mentioned is that diagnosis of coagulation factor disturbances should be performed during the menstruation cycle (1).