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At least 19 recordsLinked to original sources
PubMed1999

Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia education study.

OBJECTIVE: To determine whether an educational package could influence the management of menorrhagia, increase the appropriateness of choice of non-hormonal treatment, and reduce referral rates from primary to secondary care. DESIGN: Randomised controlled trial. SETTING: General practices in East Anglia. SUBJECTS: 100 practices (348 doctors) in primary care were recruited and randomised to intervention (54) and control (46). INTERVENTIONS: An educational package based on principles of "academic detailing" with independent academics was given in small practice based interactive groups with a visual presentation, a printed evidence based summary, a graphic management flow chart, and a follow up meeting at 6 months. OUTCOME MEASURES: All practices recorded consultation details, treatments offered, and outcomes for women with regular heavy menstrual loss (menorrhagia) over 1 year. RESULTS: 1001 consultation data sheets for menorrhagia were returned. There were significantly fewer referrals (20% v 29%; odds ratio 0. 64; 95% confidence interval 0.41 to 0.99) and a significantly higher use of tranexamic acid (odds ratio 2.38; 1.61 to 3.49) in the intervention group but no overall difference in norethisterone treatment compared with controls. There were more referrals when tranexamic acid was given with norethisterone than when it was given alone. Those practices reporting fewer than 10 cases showed the highest increase in prescribing of tranexamic acid. CONCLUSIONS: The educational package positively influenced referral for menorrhagia and treatment with appropriate non-hormonal drugs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

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

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.

Adult↗
PubMed1983

The meaning of menorrhagia: an investigation into the association between the complaint of menorrhagia and depression.

Although it is generally assumed that the complaint of menorrhagia indicates gynaecological pathology, there is evidence to suggest that it can also be a manifestation of psychological disturbance. In order to investigate this hypothesis 50 women with this complaint were assessed by means of a semi-structured interview, General Health Questionnaire (GHQ) and Eysenck Personality Questionnaire (EPQ), and blood investigations (haemoglobin and serum iron). The main finding was that 31/50 women had positive GHQ screening (GHQ+) and features consistent with mild to moderate depression. The tendency for the GHQ+ women to have evidence of less severe menstrual bleeding and greater psychological vulnerability is consistent with the original hypothesis and implies that further research in this area is warranted.

Depression↗
PubMed2001

von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia.

OBJECTIVE: To estimate the prevalence of von Willebrand disease and other bleeding disorders in women with and without diagnosed menorrhagia. METHODS: Women with menorrhagia were identified among members of a health maintenance organization in the southeastern United States through a computer search for appropriate International Classification of Diseases, 9th Revision codes. A random sample of members with no such code was selected as controls. The study included 121 women with menorrhagia and 123 controls. Subjects were interviewed in person, and blood was drawn for coagulation testing. Laboratory results for menorrhagia patients were compared with those in controls using race and blood type specific ranges developed from the control group. A test was considered abnormal if it exceeded two standard deviations below the control mean. RESULTS: Bleeding disorders (von Willebrand disease, factor deficiency, or a platelet abnormality) were diagnosed in 10.7% of menorrhagia patients and 3.2% of controls (P =.02). von Willebrand disease was present in eight menorrhagia patients (6.6%) and in one control (0.8%) (P =.02); separate analyses by race revealed a von Willebrand disease prevalence of 15.9% among white and 1.4% among black menorrhagia patients (P =.01). Women with bleeding disorders did not differ significantly from controls in other symptoms of bleeding. CONCLUSION: The prevalence of inherited bleeding disorders among white women with menorrhagia was substantial, consistent with European data published recently. For unknown reasons, the prevalence of von Willebrand disease was lower among black women. These findings indicate the importance of considering inherited bleeding disorders as a cause of menorrhagia.

Adolescent↗
PubMed1992

Menorrhagia. Current drug treatment concepts.

Since menorrhagia occurs in 9 to 14% of populations of healthy women, many general practitioners will encounter menorrhagia-related problems. Menorrhagia is difficult to objectify and the choice of treatment between the available drugs is not always an easy one. In this survey, the available knowledge on menorrhagia diagnosis, underlying pathophysiology and treatment, especially medicinal treatment, are discussed. Overall, a practical approach is emphasised. The desire for contraception as well as the underlying cause of menorrhagia determine the drug of choice in the treatment of menorrhagia. If contraception is desired, oral combination contraceptives and continuously dosed progestogens, orally or as a medicated intrauterine device (IUD), are the first choice drugs for essential menorrhagia, and for fibroid- and bleeding disorder-associated menorrhagia. If no contraception is desired, the first choice treatments are drugs that need to be administered only during menstruation, such as prostaglandin synthesis inhibitors or antifibrinolytics. Of these, antifibrinolytics reduce menstrual blood loss to the greatest extent, whereas prostaglandin synthesis inhibitors have the lowest incidence of side effects. Prostaglandin synthesis inhibitors also have the extra advantage of diminishing dysmenorrhoea. There is no place for ergometrine in the treatment of menorrhagia. No studies are available as yet on the combination of various drug treatment modalities, although such an evaluation would be desirable.

Female↗
PubMed1998

Adenomyosis: diagnosis by hysteroscopic endomyometrial biopsy, correlation of incidence and severity with menorrhagia.

OBJECTIVE: To assess the possibility of diagnosing adenomyosis by hysteroscopic endomyometrial biopsy in patients with menorrhagia and to compare the incidence and depth of penetration in patients who did not have menorrhagia. STUDY DESIGN: The study group included 53 patients who had menorrhagia and the control group included patients who were to have hysterectomy for conditions like prolapse uterus. Hysteroscopic endomyometrial biopsy was done in the menorrhagia group. The incidence and depth of penetration of adenomyosis were compared in both the groups using Kruskal Wallis H test. For correlation of severity of menorrhagia with depth of adenomyosis: Student's t-test and ANOVA were used. RESULT: The incidence of adenomyosis was 60% (18 patients) by endomyometrial biopsy in the menorrhagia group as compared to 33.3% in the control group. The mean depth of invasion of myometrium was 4.103 mm in the menorrhagia group and 2.03 mm in the control group. CONCLUSION: There is a definite correlation between menorrhagia and adenomyosis both in incidence and depth of penetration.

Adult↗
PubMed1991

Phospholipase activity in the endometrium of women with normal menstrual blood loss and women with proven ovulatory menorrhagia.

The activity of phospholipase A2 types 1 and 2 and phospholipase C was measured in the endometrium of women with ovulatory menorrhagia and in those with normal menstrual blood loss. In both groups of subjects phospholipase A2 type 1 activity was significantly higher in the secretory phase than in the proliferative phase (P less than 0.001). The median activity (pmol/mg protein/min) for the proliferative phase was 27.6 in normal subjects and 40.4 in women with ovulatory menorrhagia and for the secretory phase the median activity was 144.5 in normal women and 138.1 in women with ovulatory menorrhagia. There was no difference between the two groups of women at either stage of the cycle. Phospholipase A2 type 2 activity was also higher in the secretory phase than in the proliferative phase (P less than 0.05 for normal subjects and P less than 0.001 for women with menorrhagia). The median activity (pmol/mg protein/min) for the proliferative phase was 94.4 (normal subjects) and 56.6 (women with menorrhagia) and for the secretory phase 148.3 (normal subjects) and 142.5 (women with menorrhagia). The activity of phospholipase A2 type 2 was significantly lower in the proliferative phase of women with ovulatory menorrhagia compared with normal subjects (P less than 0.05). Phospholipase C activity (nmol/mg protein/min) was significantly higher in women with ovulatory menorrhagia (median 8.2) compared with women with normal blood loss (median 5.5) (P less than 0.01).

Endometrium↗
PubMed2000

Induction of endometrial plasminogen activator-inhibitor 1: a possible mechanism contributing to the effect of intrauterine levonorgestrel in the treatment of menorrhagia.

OBJECTIVE: To elucidate molecular mechanisms accounting for excessive menstrual blood loss, and to present the therapeutic effect of an intrauterine levonorgestrel system (LNG-IUS) in menorrhagia. DESIGN: A multicenter study comparing hysterectomy with the LNG-IUS in treating menorrhagia. SETTING: A university hospital. PATIENT(S): Women with (n = 27) and without (n = 14) menorrhagia, and women with uterine fibroids but undetermined menstrual blood loss (n = 35). INTERVENTION(S): An LNG-IUS was inserted into the uterine cavity in 11 women with menorrhagia and six women experiencing normal menstrual blood loss. MAIN OUTCOME MEASURE(S): Expression of the messenger ribonucleic acid (mRNA) of tissue-type plasminogen activator (t-PA) and that of a specific PA inhibitor type 1 (PAI-1) in endometrial tissue samples, as evaluated with the use of Northern blot analysis. RESULT(S): t-PA mRNA was expressed in the endometrium throughout the menstrual cycle, with no statistically significant difference between a proliferative (n = 30) and a secretory endometrium (n = 40), or between women experiencing normal menstrual blood loss (n = 14) and those with menorrhagia (n = 27). The levels of t-PA mRNA in menstrual phase samples (n = 6) were significantly higher than those in proliferative or secretory endometrium. PAI-1 mRNA was detected in the endometrium during menstruation only. Both t-PA mRNA and PAI-1 mRNA were expressed in all endometrial samples (n = 17) obtained 6 months after an LNG-IUS was inserted, regardless of the menstrual cycle phase. The relative levels of both types of mRNA were significantly higher in LNG endometrium than in proliferative or secretory endometrium, but levels did not differ from those in menstrual-phase endometrium. CONCLUSION(S): The mean (+/-SD) levels of t-PA mRNA and PAI-1 mRNA in the endometrium of women with and without menorrhagia did not differ, suggesting that the PA system is not the major determinant of menstrual blood loss. However, continuous induction of PAI-1 may contribute to the therapeutic effect of LNG-IUS in treating menorrhagia.

Adult↗
PubMedDate not supplied

General practitioners' perceptions of the illness behaviour and health needs of South Asian women with menorrhagia.

OBJECTIVES: A study of general practitioners' (GPs) perceptions of the health needs of women of South Asian descent who suffer from menorrhagia. METHOD: A qualitative study using semi-structured interviews with 50 GPs in two British towns. FINDINGS: This study suggest that some women of South Asian descent may not consult their GPs even though suffering severe menorrhagia. Moreover, some GPs perceive that women may suffer from anaemia as the result of such illness behaviour. One reason for this reluctance to consult for menorrhagia may be the fact that some women of South Asian descent prefer to be examined by female doctors, yet may attend practices that lack a female partner. The study also shows that South Asian women, who consult male GPs for menorrhagia, are sometimes referred to hospital outpatients without internal examinations, and that women may be reluctant to keep their hospital appointments because of the lack of female gynaecologists. The study also indicates that a shortage of female interpreters may make communication difficult between some health care professionals and their patients, particularly when a complex and sensitive subject such as menorrhagia needs to be discussed. CONCLUSION: Women of South Asian descent may suffer serious problems such as iron deficiency anaemia, partly due to untreated menorrhagia. Since this was a study of GPs' perceptions of the health needs of South Asian women, it is now important to interview women themselves, to learn more about their perceptions of menorrhagia, and their perceptions of any subsequent contact with health care professionals.

Anemia, Iron-Deficiency↗
PubMed1997

Endothelin and neutral endopeptidase in the endometrium of women with menorrhagia.

The mechanisms underlying excessive menstrual bleeding or menorrhagia are not understood. In view of its potent vasoconstrictor and growth factor properties, endothelin has been proposed to have a potential paracrine role in the regulation of uterine blood flow and therefore could be a factor in menorrhagia. We compared the cellular localization of endothelin and its metabolizing enzyme, neutral endopeptidase, in endometrial biopsies from women with documented menorrhagia and in those with a normal menstrual cycle. Menorrhagia was documented by measurement of menstrual blood loss, 146 +/- 141 ml (median +/- SD). Endothelin and neutral endopeptidase were localized by immunohistochemistry, and the staining intensity was graded. Their immunostaining patterns were found to differ in menorrhagia compared to the normal menstrual cycle. Endothelin was reduced in glandular epithelium in menorrhagia and did not vary cyclically, while neutral endopeptidase was increased in the glandular epithelium. In menorrhagia, stromal endothelin immunoreactivity was not different from the normal cycle and although neutral endopeptidase immunostaining in stroma was similar to the secretory phase of normal endometrium, cyclical variation was absent. The potential for increased metabolism of endothelin could be an explanation for the decreased endothelin immunostaining in the glandular epithelium.

Endometrium↗
PubMed1996

Endothelial cell proliferation in the endometrium of women with menorrhagia and in women following endometrial ablation.

Local endometrial aberrations are thought to be the major contributing factor to essential menorrhagia. Here we have examined the role of endometrial angiogenesis, the growth of new blood vessels, in essential menorrhagia. Our study tested two hypotheses: firstly that angiogenesis is disturbed in the endometrium of women with menorrhagia; and secondly that when menstrual blood loss is decreased following endometrial ablation, an endometrial environment favouring normal angiogenesis has returned. Angiogenesis was measured by endothelial cell proliferation. Proliferating endothelial cells were identified by an immunohistochemical double staining technique. A total of 57 women participated in this study, of whom 19 were controls, 20 had menorrhagia and 18 were 3-6 months post-ablation. There was a significant increase in endothelial cell proliferation in the endometrium of patients with menorrhagia compared with the control endometrium. Conversely, post-ablation endometrium showed a non-significant decrease in endothelial cell proliferation. The increased endothelial cell proliferation in the endometrium of patients with menorrhagia was not the result of a general increase in endometrial cellular proliferation and did not result in a change in endothelial cell concentration compared with control endometrium. These results support the hypothesis that angiogenesis is disturbed in the endometrium of patients with menorrhagia and normalized in post-ablation endometrium.

Adult↗
PubMed1998

Development and validation of the Menorrhagia Outcomes Questionnaire.

OBJECTIVE: To develop and evaluate the acceptability, reliability and validity of a short, patient-based questionnaire for assessing the outcomes of surgical treatment for menorrhagia due to benign disease. DESIGN: A psychometric study by postal survey. SETTING: Five hospitals in southeast England. SAMPLE: One hundred and eleven women undergoing hysterectomy for menorrhagia due to benign disease. METHODS: Data from a long research questionnaire used in the North West Thames Hysterectomy Study were analysed using standard psychometric methods to identify the subset of items which were the most scientifically sound indicators of outcome. The Menorrhagia Outcomes questionnaire is a 26-item questionnaire which covers symptoms, post-operative complications, quality of life, and women's satisfaction with outcome. The questionnaire was field tested for acceptability, reliability and validity by postal survey. RESULTS: The Menorrhagia Outcomes Questionnaire was found to be highly acceptable to women and showed excellent internal consistency, test-retest reliability, criterion and construct validity. CONCLUSION: The Menorrhagia Outcomes Questionnaire is a practical and scientifically sound measure of outcome from the woman's perspective following surgical treatment for menorrhagia due to benign disease. It takes less than five minutes to complete, is appropriate for use with different surgical treatments for menorrhagia (eg. hysterectomy, endometrial resection, laser ablation) and is feasible for routine monitoring of large numbers of women by postal survey. Most importantly, this questionnaire has been shown to perform well from a scientific point view, having met standard psychometric criteria for reliability and validity.

Adolescent↗
PubMed2001

Psychosocial and other characteristics of women complaining of menorrhagia, with and without actual increased menstrual blood loss.

OBJECTIVE: To discover whether psychosocial factors can explain why many women with normal menstrual blood loss seek care for menorrhagia. DESIGN: Cross-sectional comparative study of women referred for menorrhagia. SETTING: Gynaecology departments of all five university teaching hospitals in Finland. SAMPLE: Two hundred and twenty-six women aged 35-49 years complaining of menorrhagia. MAIN OUTCOME MEASURES: Several psychosocial factors, seeking medical attention, menstrual blood loss. RESULTS: Twenty-nine percent of the women had their menstrual blood loss in the normal range (menstrual blood loss <60 mL). By univariate analysis, unemployment, anxiety, perceived inconvenience, abdominal pain, haemoglobin level and serum ferritin concentration distinguished this group of women from those with true menorrhagia. Unemployment, perceived inconvenience, abdominal pain and serum ferritin remained significant variables by multivariate analysis. CONCLUSIONS: A significant proportion of women with complaints of menorrhagia have their measured menstrual blood loss within the normal range. Psychosocial factors can have an impact on their seeking health care. Better understanding of the factors, which explain complaints of menorrhagia in women with normal bleeding could improve both medical outcomes and reduce the cost of treatment for menorrhagia.

Adult↗
PubMed2004

von Willebrand disease in women with menorrhagia: a systematic review.

OBJECTIVE: To determine the prevalence of von Willebrand disease in women presenting with menorrhagia. DESIGN: Systematic review of studies evaluating the prevalence of von Willebrand disease in women with menorrhagia. SETTING: Hospital outpatient clinics (mainly gynaecological) and population surveys. POPULATION: Women presenting with menorrhagia. METHODS: Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences. MAIN OUTCOME MEASURES: Number of women with von Willebrand disease. RESULTS: Eleven studies were included, totalling 988 women with menorrhagia. One hundred and thirty-one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% CI 11-15.6%). The prevalence was higher in the European studies-18% (95% CI 15-23%) compared with that in North American studies-10% (95% CI 7.5-13%). This difference (P= 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race- and ABO blood group-specific values for von Willebrand factor. CONCLUSIONS: The prevalence of von Willebrand disease is increased in women with menorrhagia and is the underlying cause in a small but significant group of women with menorrhagia across the world. Testing for this disorder should be considered when investigating women with menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms.

Europe↗
PubMed1996

How do New Zealand gynaecologists treat menorrhagia?

The objectives of this study were to establish the criteria and technique that New Zealand gynaecologists use for endometrial sampling for women with menorrhagia, and to establish the preferred medical therapy for menorrhagia. A postal survey of all practising gynaecologists in New Zealand was undertaken. Questions were asked regarding which women with menorrhagia should have an endometrial biopsy, what sampling method they used, and their first, second and third line medical treatments. There were 68 replies (48% response rate). There was no general agreement on the mean age at which women with menorrhagia should have an endometrial sample. Forty-six percent preferred hysteroscopy to sample the endometrium, and 41% preferred a pipelle suction curette. The most favoured first-line choice used to treat menorrhagia was luteal phase progestogens (54%). The most-favoured second choice was the nonsteroidal antiinflammatory drugs (NSAIDs), and the most favoured third choice was danazol. The results from this study suggested that protocols need to be developed in order to prevent women with menorrhagia from being inappropriately investigated or suboptimally treated. It is possible that the high hysterectomy rate in New Zealand could be reduced if gynaecologists were to use more effective treatment earlier in the clinical presentation of menorrhagia.

Adult↗
PubMed1994

Cyclic changes in endometrial tissue plasminogen activator and plasminogen activator inhibitor type 1 in women with normal menstruation and essential menorrhagia.

OBJECTIVE: The purpose of this study was to investigate the role of fibrinolysis in the pathogenesis of essential menorrhagia. STUDY DESIGN: We measured fibrinolytic activity and the concentration of the fibrinolytic activators, tissue plasminogen activator, and plasminogen activator inhibitor type 1 in endometrial extracts at various stages of the menstrual cycle in patients with normal menstrual loss (< or = 80 ml per cycle) and essential menorrhagia (> 80 ml per cycle). Tissue plasminogen activator activity was assayed by measuring the rate of conversion of Glu-plasminogen to plasmin with a chromogenic plasmin substrate. Enzyme-linked immunoassays were used to measure tissue plasminogen activator and plasminogen activator inhibitor type 1 antigen levels. RESULTS: Women with essential menorrhagia had higher endometrial tissue plasminogen activator activity in the menstrual phase compared with controls (p < 0.01). Endometrial tissue plasminogen activator antigen levels were higher in both the late secretory (p < 0.01) and menstrual (p < 0.001) phases in essential menorrhagia than in the normal group. Endometrial plasminogen activator inhibitor type 1 was significantly higher in essential menorrhagia only in the menstrual phase (p < 0.01). CONCLUSION: The premenstrual rise in tissue plasminogen activator antigen production with delayed increase in plasminogen activator inhibitor type 1 is the probable cause of the greater endometrial tissue plasminogen activator activity that occurs during menstruation in women with essential menorrhagia.

Adult↗