Methodological issues in menstrual research: menorrhagia reconsidered

Abstract

BACKGROUND: Menorrhagia (excessive periods) is a very common reason for consultation with general practitioner, and the most common reason for referral to gynaecology clinic. The clinical definition is blood loss exceeding 80mls per period but measurement is seldom undertaken in routine clinical practice. Research has shown that many women presenting with menorrhagia have volume of blood loss in the normal range and that women's concerns are mainly the impact of periods on their lives, less about the volume of blood loss. The clinical definition of menorrhagia requires reconsideration, to better reflect the contemporary menorrhagia complaint.AIM: To examine the multi-faceted menorrhagia complaint in terms of: subjective account of menstrual periods and symptoms, psychosocial measures, socio-demographic factors, and objective measurement of the menstrual loss.STUDY DESIGN: The research comprises three overlapping parts: (1) a cross-sectional survey with (2) an embedded detailed prospective menstrual collection study, and (3) a follow-up (cohort) study of the earliest recruits to the survey group, the latter undertaken by case-note review. Local Ethical Research Committee approval was obtained for the study.STUDY POPULATION: All women aged 25 to 49 years newly referred for menstrual problems to collaborating consultants at gynaecology clinics at Edinburgh and Glasgow Royal Infirmaries, and Glasgow Western Infirmary. Problems eligible for inclusion in the survey were excessive periods, period pain, premenstrual changes, 'period problems' (non-specific) and irregular periods. Only those with putatively heavy periods (referral for that reason, or subjective judgement) were invited to have their blood loss measured

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