# 104 - Gynaecological and obstetric haemorrhage

# Gynaecological and obstetric haemorrhage

Depression and anxiety disorders
CHAPTER 3
One database study37 also identified an increased risk of ICH in those who have been 
taking SSRIs alone or in combination with NSAIDs. This and other studies providing 
data on absolute risk are summarised in Table 3.21, which gives estimates of absolute 
risk of ICH derived from three studies.
Gynaecological and obstetric haemorrhage
A multicentre cross-­sectional study39 found an association between the use of antidepressants and menstruation disorders (unusual or excess bleeding, irregular menstruation, menorrhagia, etc.). This study found that the prevalence of menstruation 
disorder in the study group who were taking SSRIs, venlafaxine or mirtazapine, 
either alone or in combination, was 24.6% compared with 12.2% in people not 
taking antidepressants.
Abnormal vaginal bleeding
Cases of abnormal vaginal bleeding associated with SSRIs have been reported in a 
young woman,40 a postmenopausal woman41 and a preadolescent girl aged 11.42
Postpartum haemorrhage
While one study43 could not find an increased risk of postpartum haemorrhage (PPH) 
with the use of SSRI or non-­SSRI antidepressants, a large cohort study44 found an association between PPH and all classes of antidepressants, with a number needed to harm 
of 80 for current users of SSRIs and 97 for those on other antidepressants. One hospital-­
based cohort study45 found an absolute risk of PPH of 18% and an absolute risk of 
postpartum anaemia of 12.8% after a non-­surgical vaginal delivery in women who 
were current users of SSRIs. The absolute risk of both PPH and postpartum anaemia 
for those without any exposure to antidepressants was 8.7%. The blood loss during 
delivery was also higher for those who had SSRI exposure. The length of hospital stay 
was also significantly increased for those who had been taking an SSRI. A recent population study46 identified that the use of serotonergic medications was associated with 
1.5 times increased risk of PPH. This study highlighted that women who have been 
taking other psychoactive medications such as antipsychotics and mood stabilisers 
Table 3.21  Absolute risk of intracranial haemorrhage with SSRI with or without anticoagulant or NSAIDs.
Study
Risk with SSRI alone
Risk with SSRI + NSAID
Risk with antidepressant 
+ anticoagulant
Shin et al. 201537
1 in 632* (0.16%)
1 in 175* (0.57%)
–
Renoux et al. 20176
1 in 450** (0.22%)
–
1 in 260** (0.38%)
Smoller et al. 200938
1 in 240*** (0.42%)
–
–
* Within 30 days of taking antidepressant.
** Incident users (no time limit).
*** Annual risk (older patients).