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  • Print publication year: 2014
  • Online publication date: June 2014

1 - Introduction

Summary

This introduction discusses the aetiology of menstrual problems, their presentation and investigation as well as medical and surgical management. Specific problems such as fibroid-associated bleeding, adolescent and perimenopausal bleeding and breakthrough bleeding are covered, as are other critically important problems such as premenstrual disorders, pelvic pain and dysmenorrhoea. The most common presenting menstrual problem is heavy menstrual bleeding (HMB). A woman's approach to her periods will vary through her reproductive life. After childbearing is completed, the view of the menses will alter dramatically. The longest intermenstrual interval occurs at the menarche. Menstrual irregularity is most likely to occur at the extremes of reproductive life, the incidence of anovulation increasing as the menopause approaches. Classical primary spasmodic dysmenorrhoea occurs at the onset of the menses and gets better after 1 or 2 days, whereas secondary dysmenorrhoea tends to start prior to the menses and worsens as it proceeds.

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References

1. National Institute for Health and Clinical Excellence. Heavy Menstrual Bleeding. NICE clinical guideline 44. London: NICE; 2007.
2. ReesMCP, TurnbullAC. Menstrual disorders – an overview. Baillieres Clin Obstet Gynaecol 1989;3:217–26.
3. FraserIS, CritchleyHO, BroderM, MunroMG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med 2011;29:383–90.
4. ChimbiraTH, AndersonAB, TurnbullAC. Relation between measured menstrual blood loss and patient’s subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area. Br J Obstet Gynaecol 1980;87:603–9.
5. WarnerPE, CritchleyHO, LumsdenMA, Campbell-BrownM, DouglasA, MurrayGD. MenorrhagiaI: measured blood loss, clinical features, and outcomes in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol 2004;190:1216–23.
6. HighamJM, O’BrienPM, ShawRW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol 1990;97:734–9.
7. TreolarAE, BoyntonRE, BehnBG, BrownDW. Variation of the human menstrual cycle through reproductive life. Int J Fertil 1967;12:77–126.
8. FraserIS, McGarronG, MarkhamR, RestaT, WattsA. Measured menstrual blood loss in women with pelvic disease or coagulation disorder. Obstet Gynecol 1986;68:630–3.
9. HarlowSD, GassM, HallJE, LoboR, MakiP, RebarRW, et al.; STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause 2012;19:387–95.