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Contributed by Mr Antonio V Antoniou, consultant gynaecologist and lead in minimal access surgery and urogynaecology, Newham University Hospital and London Independent Hospital, London
Section 1: Epidemiology and aetiology
Abnormal menstruation includes menorrhagia (blood loss greater than 80ml), intermenstrual bleeding (IMB), postcoital bleeding (PCB, defined as bleeding occurring during or immediately after sexual intercourse at a time distinct from menstruation), oligomenorrhoea and amenorrhoea.
Periods can also be irregular and prolonged (metrorrhagia).
NICE defines menorrhagia as excessive menstrual blood loss that interferes with a woman's physical, emotional, social and material quality of life.1
Menorrhagia is the predominant complaint in women with abnormal uterine bleeding. One in 20 women aged between 30 and 49 years will consult their GP each year with menorrhagia.2
These bleeding disturbances are classified as dysfunctional when no pathologic abnormality can be demonstrated. Amenorrhoea will not be discussed in this article.
Prevalence rates in the population vary from 4 to 27 per cent.1
Abnormalities in menstrual bleeding are a common cause of consultation in general practice as well as specialist referral to hospital.3
The causes of abnormal uterine bleeding are many and include complications of pregnancy, benign and malignant lesions, as well as dysfunctional uterine bleeding. The majority of women can be reassured that there is no pathology.
Uterine bleeding in very young girls before expected menarche may be caused by trauma (such as straddle injury or abuse), a foreign body (such as toys), precocious puberty or exogenous hormones.
Irregular periods are common during adolescence. The most common cause is anovulation or reduced ovulation due to the noncyclic release of follicle-stimulating hormone (FSH) and luteinising hormone (LH), which is itself due to a relatively immature hypothalamic-pituitary-ovarian axis.4 This can last for a couple of years after menarche.
It is …