Treatments for heavy menstrual bleeding: guidelines improve prescribing practice but may not affect hysterectomy rates.(Editorial)

Heavy menstrual bleeding is a common cause of iron deficiency anaemia and may affect a woman's quality of life. Thirty per cent of women consider their menstruation to be excessive. (w1) In more than half of women with menorrhagia no obvious cause for the bleeding is found, and in at least half of those who undergo hysterectomies in the United Kingdom heavy menstrual bleeding is the main presenting problem Concern has been expressed that unnecessary surgery is being performed, and treatment of this common condition is not appropriate and evidence based. (1)

One difficulty with the available research is that the focus has been on trying accurately to measure blood loss as a response to treatment. There are problems with this approach. Firstly, there is a large discrepancy between women's perception of their menstrual loss mad accurate measurement of the blood flow. For example, only about half of women complaining of heavy menstrual bleeding have a menstrual loss greater than 80 ml per cycle, which is the cut-off for a clinical diagnosis of heavy menstrual bleeding. (2) Secondly, the current gold standard for measuring menstrual blood loss is a modification of the alkaline haematin technique, (3) but this method is impractical in clinical practice and not used outside a research setting and makes generalisability of studies that report only measured menstrual…