Routine evaluation and treatment of unexplained menorrhagia: do we consider haemostatic disorders?

Abstract

OBJECTIVE:

Unexplained menorrhagia can be caused by underlying bleeding disorders. The aim of this study was to investigate the current work-up of menorrhagia in routine gynaecological practice, with a special interest in haemostatic evaluation. Secondly, we investigated the outcome of individualized treatment in our centre.

STUDY DESIGN:

Retrospective medical chart review of 112 consecutive patients referred with menorrhagia to a general gynaecology clinic of a university teaching hospital in the Netherlands between January 2006 and January 2007. In April 2008 we performed a structured telephone interview evaluating the effectiveness of their therapy.

RESULTS:

We included 112 patients, whose median age was 42 years. Twenty-nine percent were anaemic (hemoglobin <12.0g/dL). Seventy-one (63%) had unexplained menorrhagia. Only two patients had haemostatic evaluation and neither had von Willebrand's disease. Forty percent (29/71) needed two or more different therapies, 17% (12/71) needed three different therapies and two patients needed a total of seven different therapies. Eight patients underwent hysterectomy, six of them after endometrial ablation. Most patients (80%) were successfully treated medically or surgically and were satisfied with their therapy during follow-up. Eleven patients declined therapy and accepted their heavy periods.

CONCLUSION:

Haemostatic evaluation in women with unexplained menorrhagia is uncommon in gynaecological practice in our centre. Although most of the patients were satisfied with their treatment, a significant number required hysterectomy and another important proportion had to accept their menorrhagia. We hypothesize that the identification of haemostatic disorders might improve care for these women.

• Authors: H Marieke Knol, Dick H Bogchelman, Hanneke C Kluin-Nelemans, Ate G J van der Zee, Jan van der Meer, Karina Meijer
• Journal: European journal of obstetrics, gynecology, and reproductive biology (Eur J Obstet Gynecol Reprod Biol) Vol. 152 Issue 2 Pg. 191-4 (Oct 2010) ISSN: 1872-7654 [Electronic] Ireland
• PMID: 20576344 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Topics

• Adolescent
• Adult
• Anemia (etiology)
• Endometrial Ablation Techniques
• Female
• Hemostatic Disorders (complications)
• Humans
• Menorrhagia (etiology, surgery, therapy)
• Middle Aged
• Patient Satisfaction
• Retrospective Studies