Menorrhagia—a pragmatic approach to the understanding of causes and the need for investigations

Fraser Is, Ian S. Fraser, I S Fraser
British journal of obstetrics and gynaecology · 1994 · vol. 101(s11) , pp. 3–7 · doi:10.1111/j.1471-0528.1994.tb13688.x · PMID:8043558 · W2004231286
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This paper discusses the challenges in objectively assessing heavy menstrual bleeding, categorizes its causes into pelvic disease, systemic disorders, and dysfunctional uterine bleeding, and outlines key investigations including blood counts and hysteroscopy.

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Abstract

Menorrhagia is a symptom denoting excessively heavy menstrual bleeding. It is a complaint that is difficult to verify objectively in many cases, even with a detailed case history. Issues of perception and tolerance of symptoms are important in whether a patient presents to a doctor, and this varies considerably from one society to another. Research studies indicate that the upper limit of normal blood loss is between 60 and 80 ml/month. Above this level women tend to become progressively iron deficient. Hence, any development which may help the precision of this assessment is valuable, and several of these will be discussed. Causes of menorrhagia can be divided into three groups: (1) pelvic diseases, such as myomata and adenomyosis; (2) systemic disorders, such as coagulopathies and hypothyroidism; and (3) dysfunctional uterine bleeding--a diagnosis of exclusion. Investigations are mainly aimed at improving the precision of the underlying diagnosis, defining the severity of the condition and excluding anaemia. Hence, the most important investigations are a full blood count, a diagnostic hysteroscopy and endometrial sampling. In clinical practice, other specific investigations need only be carried out if there are unusual features in the history or examination, or if previous treatments have failed. In a research situation there have been numerous studies aimed at elucidation of the mechanisms of heavy bleeding and some of these will be reviewed.

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Condition tags

adenomyosis

MeSH descriptors

Menorrhagia Menorrhagia Menorrhagia Menorrhagia Dilatation and Curettage Electrocoagulation Female Humans Uterine Hemorrhage Uterine Hemorrhage

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (19)

Cited by (12)

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