Take a careful history, perform a physical exam, and obtain laboratory tests

Formulate a treatment plan for current, future bleeding problems

Individualize and optimize menorrhagia treatment plan with help of gynecologist

Test family members

Perform DDAVP testing to establish response

Vaccinate with hepatitis A, B vaccines, if not previously vaccinated

Review bleeding risks associated with aspirin, NSAIDs, other analgesics

Review perioperative recommendations with patient and medical team

Review potential risks of delayed postpartum and postsurgical bleeding

Assist medical team in evaluation of symptoms, and patient in navigation of medical system

Consider mid-dose estrogens for initial treatment of menorrhagia

Use DDAVP as first-line therapy for VWD—tachyphylaxis, inconvenience limitations

Use VWF-containing concentrates in those failing DDAVP or requiring longer treatment

Consider antifibrinolytic agents as adjuncts to estrogen or DDAVP for bleeding

Avoid cryoprecipitate because of potential transmissible agent risk

Avoid heparin, aspirin, NSAIDs, and platelet inhibitory agents

Evaluate for iron deficiency when there is menorrhagia or prolonged post-procedure bleeding

Evaluate factor levels in the 8th month of pregnancy to determine peripartum treatment plan