Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data

Warner, Pamela; Critchley, Hilary O. D.; Lumsden, Mary Ann; Campbell-Brown, Mary; Douglas, Anne; Murray, Gordon D.

doi:10.1016/j.ajog.2003.11.015

Cited by 216 publications

(159 citation statements)

References 20 publications

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“…In the clinic, there are two main reasons why it is difficult to discern between 'normal' and 'abnormal' menstrual blood loss: firstly, the definition of 'normal' loss is largely subjective (7); and secondly, there are no simple and easily reproducible methods to measure blood losses. This explains why most cases of iron-deficient anemia in women with longstanding menorrhagia are diagnosed after long periods of iron-deficient erythropoiesis (10).…”

Section: Introductionmentioning

confidence: 99%

Iron-dependent erythropoiesis in women with excessive menstrual blood losses and women with normal menses

et al. 2013

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In women of fertile age, iron loss consequent to excessive menstrual discharge is by far the most frequent cause of iron-deficient anemia. However, the relationship between menstrual discharge and iron loss is poorly understood. In this prospective study, total menstrual and iron losses were assayed in a large cohort of non-anemic women and women with excessive menstrual blood losses (menorrhagia) in order to provide data useful for intervention. One hundred and five Caucasian women aged 20-45 years were recruited. Blood cell count and serum ferritin (SF) levels were determined in each case before menses. Menstrual Fluid Losses (MFL) were determined using a standardized pads' weight method. Hematin concentration was assayed by a variant of the Alkaline Hematin Method from which iron concentration was calculated. Mean SF levels were 36.2 (range 8.6-100) ng/ml in healthy women and 6.4 (range 5-14) ng/ml in patients with menorrhagia. Median values of iron lost/cycle were 0.87 mg in healthy women and 5.2 mg in patients with menorrhagia (ranges: 0.102-2.569 and 1.634-8.665 mg, respectively, p<0.001). In women with menorrhagia, iron lost/cycle strongly correlated (0.789, p<0.001) with MFL. In conclusion, healthy women with normal menses lose, on average, 1 mg iron/cycle. Average iron losses in patients with menorrhagia are, at least in our cohort, on average, 5-6 times higher than normal. Most women with menorrhagia had totally depleted iron stores. Indirect, quantitative evaluation of iron lost with menses may be useful to assess the risk of developing iron-deficient anemia in individual patients. 3 IntroductionIron is a vital element of metabolism, with the most obvious and known role played in erythropoiesis, and important functions in other intracellular processes in all tissues of the body. The uptake of iron is finely regulated (1). For physiologic iron losses, no known mechanisms of maintaining iron homeostasis have been identified, and losses appear to be related mainly to cell exfoliation (2).

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Section: Introductionmentioning

confidence: 99%

Iron-dependent erythropoiesis in women with excessive menstrual blood losses and women with normal menses

et al. 2013

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“…However, a recent study in adult women confirms that the perception of heavy menstrual flow is correlated with a higher objective volume of blood loss. 28 Attempts to measure menstrual blood loss on the basis of number of pads or tampons used per day or frequency of pad changes are subject to variables such as the individual's fastidiousness, her familiarity or comfort with menstrual hygiene products, and even variation among types and brands of pads or tampons. 29 Most report changing a pad approximately 3 to 6 times a day, although external constraints such as school rules and limited time between classes may make menstrual hygiene more problematic for adolescents than adults.…”

Section: Excessive Menstrual Flowmentioning

confidence: 99%

Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign

2006

Pediatrics

439

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Young patients and their parents often are unsure about what represents normal menstrual patterns, and clinicians also may be unsure about normal ranges for menstrual cycle length and amount and duration of flow through adolescence. It is important to be able to educate young patients and their parents regarding what to expect of a first period and about the range for normal cycle length of subsequent menses. It is equally important for clinicians to have an understanding of bleeding patterns in girls and adolescents, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate young patients' conditions appropriately. Using the menstrual cycle as an additional vital sign adds a powerful tool to the assessment of normal development and the exclusion of pathological conditions.

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“…Unfortunately, these judgments do not correlate well with actual blood loss. 55 Menorrhagia can often be managed without endometrial sampling because regular bleeding, even if heavy, is less concerning for endometrial cancer. However, if the bleeding is prolonged (Ͼ7 days) or does not respond to hormonal therapy as outlined in Figure 4, further evaluation with TVUS or endometrial sampling is indicated.…”

Section: Menorrhagiamentioning

confidence: 99%

Abnormal Uterine Bleeding: A Management Algorithm

Ely

Kennedy

Clark

et al. 2006

The Journal of the American Board of Family Medicine

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Abnormal uterine bleeding is a common problem, and its management can be complex. Because of this complexity, concise guidelines have been difficult to develop. We constructed a concise but comprehensive algorithm for the management of abnormal uterine bleeding between menarche and menopause that was based on a systematic review of the literature as well as the actual management of patients seen in a gynecology clinic. We started by drafting an algorithm that was based on a MEDLINE search for relevant reviews and original research. We compared this algorithm to the actual care provided to a random sample of 100 women with abnormal bleeding who were seen in a university gynecology clinic. Discrepancies between the algorithm and actual care were discussed during audiotaped meetings among the 4 investigators (2 family physicians and 2 gynecologists). The audiotapes were used to revise the algorithm. After 3 iterations of this process (total of 300 patients), we agreed on a final algorithm that generally followed the practices we observed, while maintaining consistency with the evidence. In clinic, the gynecologists categorized the patient's bleeding pattern into 1 of 4 types: irregular bleeding, heavy but regular bleeding (menorrhagia), severe acute bleeding, and abnormal bleeding associated with a contraceptive method. Subsequent management involved both diagnostic and treatment interventions, which often occurred simultaneously. The algorithm in this article is designed to help primary care physicians manage abnormal uterine bleeding using strategies that are consistent with the evidence as well as the actual practice of gynecologists. Abnormal uterine bleeding is a common problem, 1 and its management can be complex.2,3 Physicians are often unable to identify the cause of abnormal bleeding after a thorough history and physical examination. 4,5 The management of abnormal bleeding can involve many decisions about diagnosis and treatment, 3,6,7 which often occur simultaneously and without the benefit of comprehensive, evidence-based guidelines. The available evidence tends to focus on narrow treatment questions rather than the broad clinical approach to management. 8,17 It is not difficult to find long lists of potential causes of abnormal bleeding, but primary care physicians need practical advice about how to approach this common problem. Abnormal uterine bleeding includes both dysfunctional uterine bleeding and bleeding from structural causes. Dysfunctional bleeding can be anovulatory, which is characterized by irregular unpredictable bleeding, or ovulatory, which is characterized by heavy but regular periods (ie, menorrhagia).2 Structural causes include fibroids, polyps, endometrial carcinoma, and pregnancy complications. Abnormal bleeding can also result from contraceptive methods. Many articles have reviewed the management of abnormal uterine bleeding, 3,6,7,15,16,18,21 and they often include management algorithms. Although clinical algorithms have potential shortcomings, 22,25 there are data to support their...

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Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data

Cited by 216 publications

References 20 publications

Iron-dependent erythropoiesis in women with excessive menstrual blood losses and women with normal menses

Iron-dependent erythropoiesis in women with excessive menstrual blood losses and women with normal menses

Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign

Abnormal Uterine Bleeding: A Management Algorithm

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