Normal menstruation occurs every 21–35 days lasting on average 7 days. Normal blood loss is between 25 and 69 ml per cycle. Menstrual abnormalities can be characterized by their flow and regularity. Menorrhagia is defined as bleeding of over 80 ml with menstruation. Menometrorrhagia is irregular heavy menstruations. Menstrual abnormalities can be caused by multiple etiologies. These include gynecological abnormalities of the uterus, hormonal disorders, and systemic disorders. Prior reports have identified causes for excessive bleeding in only 50% of patients. The estimated prevalence of menorrhagia in healthy women is between 9% and 14%. Menorrhagia has been found to be a reliable predictor for coagulation and platelet disorders. In the absence of a readily identifiable cause, all adolescents with menorrhagia, especially those with anemia, should be examined for an undiagnosed coagulation defect.
Quality of life evaluations were shown to be poorer in all areas in women who had inherited bleeding disorders. As compared to controls, women with menorrhagia found that they accomplished less than they would like during menses, and their heavy flow limited their activities and the kind of work they could do. Forty-six percent of type 1 von Willebrand disease (VWD) patients reported losing on average 4 days from work or school due to menorrhagia.
The gynecologist has a unique role in being the primary care giver, who generally is the first practitioner to whom the patient presents with menstrual bleeding problems.
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