Etiology and diagnosis of heavy menstrual bleeding among adolescent and adult patients: a systematic review and meta-analysis of the literature

Abstract

Background: Heavy menstrual bleeding (HMB) is excessive menstrual blood loss that interferes with an individual's quality of life. Many individuals with HMB are inadequately managed by health care providers.

Objectives: This systematic review aims to provide a comprehensive summary of the etiologies and diagnosis of HMB while calculating the prevalence of underlying causes among premenopausal patients and quantifying the test accuracy of diagnostic strategies.

Methods: MEDLINE, EMBASE, the Cochrane Library, and Web of Science were searched since inception to include studies investigating the prevalence of underlying etiology and diagnostic accuracy of investigations for HMB. The primary outcome was the prevalence of the causes of HMB, secondary outcome included the prevalence of etiology by age. Meta-analyses were conducted via random-effects model.

Results: In total, 53 studies were included. Forty-five studies included data on the prevalence of underlying HMB etiology, totaling 41 541 patients. The overall prevalence of bleeding disorders was 30% (95% CI, 14-46); von Willebrand disease, 8% (95% CI, 7-10); platelet function defect, 9% (95% CI, 7-12); abnormal thyroid, 3% (95% CI, 0-6); and polycystic ovarian syndrome, 8% (95% CI, 4-12). Subgroup analysis showed bleeding disorders were prevalent in 16% (95% CI, -8 to 41) of adults with HMB but in 39% (95% CI 18-60) of adolescents with HMB.

Conclusion: Many diagnoses were associated with bleeding disorders and, therefore, warrant investigation when assessing a patient with HMB of unknown etiology. The causes are likely age dependent and should be considered when diagnosing HMB.

Keywords: abnormal uterine bleeding; bleeding disorder; heavy menstrual bleeding; menorrhagia; menstrual disorder.