The pathophysiology of menorrhagia

Abstract Menorrhagia is the subjective complaint of heavy periods. Its cause in the vast majority of cases is unknown. As one of the commonest referrals for gynaecological consultation (Bradlow et al. 1992) this statement may appear surprising. Yet when one considers the burden of proof needed to identify the cause of such a complex disease and when one views the highly pragmatic means used in the past to deal with the problem it is perhaps less surprising. However, a new urgency to this conundrum is now with us. Regular menstruation is the consequence of the use of wide spread fertility regulation and thus in the past has only been a problem of the developed world, about 20 per cent of the total population of women of reproductive age. However, with the spread of effective fertility regulation worldwide and the global reduction of family size, the rest of the world’s population will for the first time experience regular menstruation.