Menorrhagia and bleeding disorders

Abstract

Purpose of review: Menorrhagia affects 30% of women in reproductive age. Once referred to a gynaecologist, possible causative bleeding disorders are not routinely investigated and the risk of surgical intervention is high. This may lead to an increase in surgical complications and a negative health and psychological impact on women as well as an unnecessary financial burden on the health service.

Recent findings: Although the estimated community prevalence of bleeding disorders is 2%, these disorders are consistently reported to affect 10-20% of women with objectively documented menorrhagia and to be even higher in adolescents. Recently, underlying bleeding disorders, particularly von Willebrand's disease and platelet function disorders, have been found to be prevalent in women with menorrhagia. This article critically appraises the current literature in this field.

Summary: In the UK, 20% of all women, and 30% in the USA, have a hysterectomy before the age of 60; menorrhagia is the main presenting problem in at least 50-70%. In approximately 50% of cases, no organic pathology is determined, and dysfunctional uterine bleeding is diagnosed. Diagnosis and management of bleeding disorders may possibly reduce the need for surgical intervention, leading to a positive impact on women and the health service.