A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding

Abstract

Background: There is considerable worldwide confusion in the use of terminologies and definitions around the symptom of abnormal uterine bleeding, and these are leading increasingly to difficulties in setting up multinational clinical trials and in interpreting the results of studies undertaken in single centers.

Objective: To develop an agreement process through an international initiative to recommend clear, simple terminologies and definitions that have the potential for wide acceptance.

Design: After widespread consultation with relevant international and national organizations, journal editors, and individuals, a modified Delphi process was developed to assess current use of terminologies, followed by a structured face-to-face meeting of 35 clinicians (mostly gynecologists) and scientists in Washington, DC. Focused small-group discussions led to plenary assessment of concepts and recommendations by using an electronic keypad voting system.

Setting: An international group of experts on disorders of menstruation.

Patient(s): Women with complaint of menstrual symptoms.

Intervention(s): An international debate and consultation process.

Main outcome measure(s): Expert debate and anonymous voting on agreement through use of electronic keypads.

Result(s): There was almost-universal agreement that poorly defined terms of classical origin that are used in differing ways in the English medical language should be discarded and that these should be replaced by simple, descriptive terms with clear definitions that have the potential to be understood by health professionals and patients alike and that can be translated into most languages. The major recommendations were to replace terms such as menorrhagia, metrorrhagia, hypermenorrhea, and dysfunctional uterine bleeding. Suggestions for potentially suitable replacement terms and definitions are made.

Conclusion(s): A simple terminology has been recommended for the description and definition of symptoms and signs of abnormal uterine bleeding. This article should be a living document and should be part of an ongoing process with international medical and community debate. Classification of causes, investigations, and cultural and quality-of-life issues should be part of the ongoing process.