Menorrhagia II: is the 80-mL blood loss criterion useful in management of complaint of menorrhagia?

doi:10.1016/j.ajog.2003.11.016

American Journal of Obstetrics and Gynecology

Volume 190, Issue 5, May 2004, Pages 1224-1229

https://doi.org/10.1016/j.ajog.2003.11.016 Get rights and content

Abstract

Objective

Menorrhagia is defined in terms of statistical“abnormality”as blood loss of >80 mL. We examined the usefulness of this definition in women who were referred to gynecology clinics with heavy periods.

Study design

A questionnaire survey of 952 menstrual complaint referrals at 3 hospital gynaecology clinics in Glasgow and Edinburgh included 226 women with heavy periods who had also consented to the measurement of their blood loss.

Results

Women reported a range of problems with their periods, but absolute volume (31.2%) was less prevalent than period pain (37.5%), mood change (35.7%), and change in the amount (volume) of the period (33.8%). Although there were associations with volume, these associations were due to the heaviest and lightest of the loss groups, whereas the 2 groups with loss either side of 80 mL were virtually indistinguishable.

Conclusion

The 80-mL criterion for menorrhagia is of limited clinical usefulness because it is prognostic neither for problems nor iron status and apparently does not guide management.

Section snippets

Study design and methods

The basic study design and methods, including coding of referral reason and patient reasons for clinic attendance, were described elsewhere¹⁶; blood loss collection and measurement are described in a companion article.¹² The self-completed clinic questionnaire asked each woman to respond to 16 statements about menstrual experience and to report for each experience whether it occurs in her case and, if so, how much of a problem it poses (no/slight/marked/severe problem) and to note which of

Recruitment and participation

Recruitment for the wider study (952 participants) has been reported,¹⁶ and the characteristics of the subset who collected their used sanitary protection have been described in the companion article.¹² The 226 women who collected their used sanitary protection comprised 26% of the 865 women who satisfied the criteria for collection, and 180 of these women were recruited early enough for an 8-month follow-up by case note review (80%).

Description of menstrual experience

The distribution of measured blood losses has been reported

Comment

The most striking finding is the clinical irrelevance of the established threshold definition of menorrhagia, blood loss in excess of 80 mL. Although there is a significant trend for difficulties with containment of blood flow to become more prevalent with increasing blood loss volume, this effect is largely due to the heaviest and lightest loss groups, whereas the 2 groups with loss either side of 80 mL are virtually indistinguishable. A similar pattern is observed for iron status, for

Acknowledgements

We thank Elaine Kacser and Dorothy Lyons, the study research nurses, and the many patients who participated in this study.

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Obstetrics and Gynecology: GynecologyMenorrhagia II: is the 80-mL blood loss criterion useful in management of complaint of menorrhagia?☆

Abstract

Objective

Study design

Results

Conclusion

Section snippets

Study design and methods

Recruitment and participation

Description of menstrual experience

Comment

Acknowledgements

Lancet

Soc Sci Med

Obstets Gynecol Clin North Am

Am J Obstet Gynecol

Am J Obstet Gynecol

Lancet

Medical management of menorrhagia

BMJ

Why do women complain of menorrhagia?

Gynaecol Forum

Obstetrics and Gynecology: Gynecology
Menorrhagia II: is the 80-mL blood loss criterion useful in management of complaint of menorrhagia?☆